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Öğe Alterations in the pulmonary function tests of inflammatory bowel diseases(Aves, 2011) Ates, Fehmi; Karincaoglu, Melih; Hacievliyagil, Suleyman Savas; Yalniz, Mehmet; Seckin, YukselBackground/aims: We aimed to determine the changes in the pulmonary function tests of the patients with inflammatory bowel diseases. Methods: Forty inflammatory bowel dieases patients; 30 ulcerative colitis and 10 Crohn's disease, and age- and sex-matched control group, consisting of 30 healthy persons, were included in the study. Disease activity in patients with ulcerative colitis was assessed by Truelove and Witts Criteria and in Crohn's disease patients by Chron's Disease Activity Index. Results: Pulmonary function tests were found abnormal at least in. one parameter in, 17 / 30 ulcerative colitis patients (56%) and in 5/10 Crohn's disease patients (50%) in the activation period and in 5/30 ulcerative colitis patients (17%) and in 2/10 Crohn's disease patients (20%) in the remission period of the diseases of the same patients. Forced vital capacity, first second, residual volume 1 total lung capacity, diffusing capacity of the lung for carbon monoxide and diffusing capacity of the lung for carbon monoxide per liter alveolar volume values were found significantly impaired in the activation period in comparison with the values of the same patients in the remission period (p<0.01). It was found that pulmonary function test values in patients with inflammatory bowel dieases were not affected by either the type of disease or treatment with 5-aminosalicylic acid. However, they were affected notably by the disease activity. Conclusion: Pulmonary function test abormalities were found frequently in patients with inflammatory bowel dieases without presence of any respiratory symptoms and lung radiograph findings. The severity and frequency of these pulmonary function test abnormalities which were detected even in the remission periods increase with the activation of the disease. Therefore, pulmonary function test may be used as a non-invasive diagnostic procedure in determining the activation of inflammatory bowel dieases and might aid to the early diagnosis of the latent respiratoryÖğe An antibody of TNF-alpha did not prevent thioacetamide-induced hepatotoxicity in rats(Sage Publications Ltd, 2011) Demirel, Ulvi; Harputluoglu, Murat M. M.; Seckin, Yuksel; Ciralik, Harun; Temel, Ismail; Ozyalin, Fatma; Otlu, BarisTumor necrosis factor (TNF)-alpha antibodies have been shown to reduce liver damage in different models. We investigated the effects of infliximab (a TNF-alpha antibody) on liver damage in thioacetamide (TAA)-induced hepatotoxicity in rats. Group 1 (n = 8) was the control group. In group 2 (n = 8), the TAA group, the rats received 300 mg/kg intraperitoneal (ip) TAA daily for 2 days. In group 3 (n = 8), the TAA + Infliximab (INF) group, infliximab (5 mg/kg ip daily) was administered 48 hours before the first dose of TAA daily for 2 days and was maintained for 4 consecutive days. In group 4 (n = 8), the INF group, the rats received only ip infliximab (5 mg/kg) daily. Livers were excised for histopathological and biochemical tests (thiobarbituric-acid-reactive substances [TBARS], and myeloperoxidase [MPO]). Serum ammonia, aspartate transaminase (AST), alanine transaminase (ALT), TNF-alpha, liver TBARS and MPO levels, and liver necrosis and inflammation scores in the TAA group were significantly higher than in the control and INF groups (all p < 0.01). All parameters except AST were not significantly different between TAA and TAA + INF. In conclusion, our results suggest that oxidative stress plays an important role in TAA-induced hepatotoxicity, and infliximab does not improve oxidative liver damage.Öğe Association of CagA-positive Helicobacter pylori infection with severity of obstructive sleep apnea syndrome(Scientific Publishers India, 2016) Yildirim, Oguzhan; Bali, Ilhan; Tulubas, Feti; Mete, Rafet; Topcu, Birol; Seckin, Yuksel; Cagin, Yasir FurkanAim: To investigate the association between Helicobacter pylori cytotoxin-associated gene-A (CagA) status and the severity of OSA syndrome in infected patients. Methods: Ninty-six patients with obstructive sleep apnea syndrome (OSAS) and 30 age-and sex-matched control subjects with no history of OSA or gastrointestinal complaints were included in the study. Patients' apnea-hypopnea index (AHI) was determined by polysomnography (PSG), and serum H. Pylori IgG and cytotoxin-associated gene-A IgG was assayed by enzyme-linked immunosorbent assay (ELISA). Based on their AHI score, subjects were assigned to one of three groups: a control group (AHI<5), a mild-moderate OSAS group (AHI >= 5 and < 30), and a severe OSAS group (AHI >= 30). Results: The prevalence of H. pylori IgG seropositivity was significantly higher in the severe OSAS group compared to the mild-moderate OSAS group [ 29 (90.6%) patients versus 41 (64%) patients, (p=0.007)]. In addition, CagA seropositivity was present in 10 control patients (58.8%), 23 mild-moderate OSAS patients (56%), and 25 severe OSAS patients (86.2%). There was a significantly higher prevalence of CagA seropositivity in the severe OSAS group compared to mild-moderate OSAS group (p=0.027). There was no significant difference in CagA seropositivity between the mild-moderate OSAS group and the control group (p=0.059). Conclusion: Our findings suggest that H. pylori strains expressing CagA may be considered a risk factor in the severity of OSAS.Öğe Association of eNOS Gene Polymorphisms G894T and T-786C with Risk of Hepatorenal Syndrome(Hindawi Ltd, 2016) Seckin, Yuksel; Yigit, Ali; Yesilada, Elif; Gulbay, Gonca; Cagin, Yasir Furkan; Gozukara, Harika; Bilgic, YilmazBackground. There are no studies investigating the relationship between endothelial nitric oxide synthase (eNOS) gene polymorphisms and hepatorenal syndrome (HRS). Aim. The purpose of this study is to elucidate whether eNOS gene polymorphisms (G894T and T-786C) play a role in the development of type-2 HRS. Methods. This study was carried out in a group of 92 patients with cirrhosis (44 patients with type-2 HRS and 48 without HRS) and 50 healthy controls. Polymorphisms were determined by polymerase chain reaction (PCR) and melting curve analysis. Results. We did not find any significant difference in allele and genotype distributions of the eNOS -T-786C polymorphism among the groups (p = 0.440). However, the frequency of GT (40.9%) and TT (13.6%) genotypes and mutant allele T (34.1%) for the eNOS G894T polymorphism were significantly higher (p < 0.001 and p < 0.001, resp.) in the HRS group than in both the stable cirrhosis (14.6%, 4.2%, and 11.5%, resp.) and the control (22.0%, 2.0%, and 13.0%, resp.) groups. Conclusion. The occurrence of mutant genotypes (GT/TT) and mutant allele T in eNOS -G894T polymorphisms should be considered as a potential risk factor in cirrhotic patients with HRS.Öğe Could platelet indices be prognostic biomarkers for mild or severe acute pancreatitis?(E-Century Publishing Corp, 2016) Bilgic, Yilmaz; Akbulut, Sami; Kutlu, Orkide; Colak, Cemil; Yilmaz, Cengiz; Seckin, Yuksel; Cagin, Yasir FurkanThe aim of this study was to show the relation of platelet indices with the severity of acute pancreatitis (AP) and if they have any correlation with the severity of AP. Forty-seven patients with AP hospitalized in Department of Gastroenterology, Inonu University Faculty of Medicine were divided into two groups, namely, the severe AP group (n=15) and the mild AP group (n=32). The scores of these patients at days 0, 3 and at the beginning of remission according to the prognostic scoring systems (Ranson, APACHE II, and BISAP criteria), CRP, sedimentation and platelet indices (platelet count, MPV, PDW and PCT) were noted. Mann-Whitney U test was used to compare the groups. Spearman's Rho test was used to evaluate the correlations between the platelet indices and other prognostic factors. Significant differences were found between the groups as regards platelets (P<0.02), PDW (P<0.001), AST (P<0.001), ALT (P<0.001), Total bilirubin (P<0.007), LDH (P<0.001), CRP (P<0.001), sedimentation (P<0.001), APACHE-II (P<0.001), Ranson (P<0.002) parameters. When considered for the correlation between the platelet indices and other prognostic factors, it was seen that all the platelet indices showed strong positive or negative correlation in mild AP with other prognostic scoring systems, CRP and sedimentation. In contrast, it was seen that platelet indices in severe AP cases did not show strong correlation with other prognostic scoring systems, CRP and sedimentation. We showed that platelet derivatives can be used as a good prognostic biomarker for the course of mild AP. In severe AP cases, however, usability of platelet indices must be supported with further studies.Öğe Does the tumor necrosis factor a predictor factor in patients with chronic hepatitis B and C(Allied Acad, 2017) Bilgic, Yilmaz; Seckin, Yuksel; Cagin, Yasir Furkan; Yildirim, Oguzhan; Yilmaz, Cengiz; Harputluoglu, Murat; Harputluoglu, HakanAim: In our research, we aimed to investigate the importance and pattern of Tumor Necrosis Factor (TNF) alpha in response to the combinatorial treatment of lamuvidin (LAM) and Pegile interferon (PEG INF) 2a + Ribavirin (RIB) in patients with Chronic Hepatitis B (CHB) and Chronic Hepatitis C (CHC). Material and method: Thirty four CHB and 25 CHC patient samples were taken before and after the treatment and stored appropriately. CHB patients were treated with LAM and CHC patients were treated with using the combination of PEG INF 2a and RIB. HBV DNA, anti HBe, ALT, AST and TNF alpha results were obtained from CHB patients before and 48th week of the treatment. HCV RNA, ALT, AST and TNF alpha results were also obtained from CHC patients before and in the 6th month of completing the treatment. Responses to the treatment were taken as negative result of HBV DNA in CHB patients after finishing the treatment and as negative result of HCV RNA in CHC patients after 6 months of finishing the 48 weeks of PEG INF treatment. Results: At the level of decreasing TNF-alpha in CHB patients when the group responding to the treatment compared to the group not responding to the treatment, a significant difference was observed in favor of the respondent group (p< 0.0001). At the level of decreasing TNF-alpha in CHC patients when the group responding to the treatment compared to the group not responding to the treatment, a significant difference was also obtained in favor of the respondent group (p< 0.0001). In the analysis for emphasizing the importance of TNF alpha level in response to the treatment in CHB patients, it was found that predicting the response to the treatment of TNF alpha was 78.6% sensitivity and 75% specificity for 68.78 cutoff. In the analysis for emphasizing the importance of TNF alpha level in response to the treatment in CHC patients, it was found that determining the response of TNF alpha to the treatment was 100% sensitivity and 100% specificity for 122.4 cutoff. Conclusions: With the treatment a decrease in TNF alpha is occured in CHB and CHC patients; however, TNF alpha decrease in the groups responding to the treatment is more significant. The results of this research show that TNF alpha level may be an important non-invasive marker for foresight and determining the response to the treatment.Öğe Drug induced autoimmune hepatitis: a single center experience.(Allied Acad, 2017) Bilgic, Yilmaz; Harputluoglu, Hakan; Yilmaz, Cengiz; Karadag, Nese; Cagin, Yasir Furkan; Akbulut, Sami; Seckin, YukselObjective: Many drugs such as minocycline, nitrofurantoin, halothane, non-steroidal anti-inflammatory drugs, anti TNF (Tumor Necrosis Factor) antagonists can induce the autoimmune hepatitis. Herein, we aimed to assess patients suffering from drug induced autoimmune hepatitis who were hospitalized with acute hepatitis like transaminase elevations to our clinic between 2009-2015. Method: The patients were determined using simplified diagnostic criteria of the International Autoimmune Hepatitis Group. Results: We determined 9 patients whose score were compatible with the diagnosis of Autoimmune hepatitis (AIH). Three patients were older than 50, and six patients were between 19 and 31. Seven of nine patients were female. The drugs thought responsible for AIH were as follows; ciprofloxacin alone, amoxicillin plus nimesulid, amoxicillin plus ornidazole, amoxicillin alone, a combined oral contraceptive pill plus a mixture of natural drugs, metronidazole plus dexketoprofen, ramipril plus metronidazole, levofloxacin alone and venlafaxine plus mianserin for each case. Five of nine patients had been followed up conservatively upon discontinuation of drug(s) and did not need any treatment during hospitalization and resolved spontaneously. Four patients received immunosuppressive treatment which was withdrawn in 3 of those 4 patients after 3 to 6 months upon remission without relapse. Conclusion: Drug induced autoimmune hepatitis (DIAIH) can be presented with acute hepatitis of unknown etiology. Female sex seems to be a risk factor for DIAH. Treatment decisions should be given according to patient's clinical status and follow up at acute presentations. There can be no treatment need, but, when needed generally a short course of immunosuppressive treatment can be sufficient.Öğe Effectiveness of human albumin solution in the treatment of patients with cirrhosis(2022) Cengiz, Ayse Nuransoy; Cagin, Yasir Furkan; Seckin, Yuksel; Karıncaoğlu, MelihAbstract Aim: Human serum albumin is synthesized in the liver and is the main plasma protein responsible for plasma oncotic pressure. Studies on the use of Human albumin solution (HAS) in patients with cirrhosis, for prevention of cirrhosis complications or for treatment are ongoing. The beneficial role of albumin beyond volume expansion is an evolving topic, and further research is needed to understand its role in modulating biological functions and disease processes, particularly in liver disease and sepsis, but also in other diseases that involve albumin dysfunction. Materials and Methods: We investigated the effectiveness of HAS through the patients with cirrhosis who received 3 consecutive days (2x1 per day) 190-210 g / L protein were retrospectively analyzed. Results: Albumin infusion was found to be beneficial for serum albumin levels in the patient with high Child-Pugh scores. Conclusion: The complications of cirrhosis can be reduced, particularly in patients awaiting transplantation, by support with HAS treatment.Öğe Eosinophilic ascites, as a rare manifestation of eosinophilic gastroenteritis: A case report(2018) Cagin, Yasir Furkan; Berber, İlhami; Bilgic, Yilmaz; Erdogan, Mehmet Ali; Yildirim, Oguzhan; Altunel Kilinc, Elif; Seckin, Yuksel; Akatli, Ayşe NurEosinophilic ascites (EA) can present as an unusual finding of eosinophilic gastroenteritis. We presented this case to remind eosinophilic acid in cases with unexplained etiology. A 29-years old man presented to an emergency department with abdominal swelling, progressively worsening nausea, and fatigue over one month. The patient had no history of allergic disease. There was moderate ascites in the physical examination. Percent eosinophil was 60% in peripheral blood smear while IgE level was increased in the serum. There was ascites on abdominal computed tomography (CT) scan. Serum ascites-albumin gradient (SAAG) was non-portal. Eosinophilic infiltration was detected biopsy samples obtained by upper GI tract endoscopy and in bone marrow aspiration and biopsy. The abdominal pain, ascites and all laboratory tests were completely recovered after 12 weeks of prednisolone therapy. Eosinophilic gastroenteritis should be considered in case of markedly increased eosinophilia in ascites fluid.Öğe Gastrointestinal amyloidosis occurring in three different patterns: Case serie(2019) Cagin, Yasir Furkan; Caliskan, Ali Riza; Bilgic, Yilmaz; Yildirim, Oguzhan; Erdogan, Mehmet Ali; Seckin, Yuksel; Alan, Saadet; Karadag Soylu, NeseSystemic amyloidosis is a rare disease characterized by extracellular accumulation of amyloid protein in one or more organs. In patients with systemic amyloidosis, the most frequently affected organs are kidney and heart, followed by the nervous system, soft tissues, and lungs. Small bowel and liver involvement are also frequent in systemic amyloidosis. Gastrointestinal (GI) findings are common, and the degree of organ involvement determines the symptoms. Patients usually have nonspecific findings such as abdominal pain, nausea, diarrhea, and dysphagia, which may delay the appropriate diagnosis. Liver involvement occurs in the majority of patients, but the symptoms typically do not happen unless a marked hepatic amyloid deposition occurs. Diagnosis is by tissue biopsy. Treatment and prognosis depend on the underlying disease. GI system involvement is a sign of poor prognosis. In this case series, five patients who were diagnosed with gastrointestinal system amyloidosis in our clinic are presented.Öğe The influence of vitamin D deficiency on eradication rates of Helicobacter pylori(Wroclaw Medical Univ, 2017) Yildirim, Oguzhan; Yildirim, Tulay; Seckin, Yuksel; Osanmaz, Pelin; Bilgic, Yilmaz; Mete, RafetBackground. Helicobacter pylori eradication therapy improves the healing of various gastro-duodenal diseases such as chronic gastritis and peptic ulcer, and also reduces gastric cancer incidence. Several studies have reported on risk factors other than antibiotic resistance related to Helicobacter pylori eradication failure. Objectives. In this study, we aimed to investigate whether or not the serum levels of 25-hydroxy-vitamin D (25(OH)D) influence eradication rates of H. pylori. Material and methods. 220 patients diagnosed with H. pylori gastritis using endoscopic biopsy had their 25-OH vitamin D levels measured via the electrochemiluminescence method before beginning eradication therapy of H. pylori. Gastric biopsies obtained at endoscopy were examined for H. pylori strains and histopathologic findings. All patients were treated with bismuth-containing quadruple therapy for 14 days. H. pylori eradication was determined via the 14C-urea breath test performed 4 weeks after the end of therapy. Based on the 25-OH vitamin D levels, the patients were divided into 2 groups: group 1 (deficient) had a vitamin D level of < 10 ng/mL, while group 2 (sufficient) had a vitamin D level of >= 10 ng/mL. Results. Eradication was successful in 170 (77.2%) patients and failed in 50 (22.7%) patients. The prevalence of 25(OH)D deficiency was 30.5%. Mean 25(OH)D levels were significantly lower in the eradication failure group compared to the successful treatment group (9.13 +/- 4.7 vs 19.03 +/- 8.13; p = 0.001). There were significantly more patients with deficient 25(OH)D levels in the failed treatment group compared to the successful treatment group (p = 0.001). Conclusions. Our findings suggest that 25-OH vitamin D deficiency may be considered a risk factor related to eradication failure of H. pylori, which may lead to a need for supplementation of vitamin D before eradication of H. pylori.Öğe Intestinal pseudo-obstruction on the setting of celiac disease: a case report(2017) Erdogan, Mehmet Ali; Cagin, Yasir Furkan; Seckin, Yuksel; Atayan, Yahya; Bilgic, YilmazÖğe Investigation of hepatitis B virus prevalence and reactivation frequency in malignancy patients administering chemotherapy(2021) Cengiz, Muhammet; Seckin, Yuksel; Cagin, Yasir; Nuransoy Cengiz, AyseAim: This study aimed to investigate the frequency at which physicians test hepatitis B virus (HBV) serology before treatment and the rate of hepatitis B virus reactivation (HBVr) after treatment in patients undergoing chemotherapy (CT) due to a solid organ malignancy (SOM) or hematological malignancy (HM). Materials and Methods: Baseline clinical feature, HBV serology, and liver function test data for 1275 patients ≥ 18 years of age who underwent CT for the first time due to various SOMs and HMs from 2015-2017 were obtained from the database and retrospectively analyzed. HBV serology was studied in 296 (201 HM, 95 SOM) of the 1275 patients retrieved from the database. Results: The prevalence of HBV was 9.5% (121 patients). Only 49 (40.4%) HBV-positive patients had HBV DNA. Of those, 72 (59.5%) underwent prophylactic antiviral therapy. HBVr was detected in only 3 patients (1.5%), and all of those patients had HMs and were recommended oral antiviral therapy but did not. Conclusion: In patients with SOMs, the screening rates of HBV serology, as well as prophylaxis and follow-up HMs were extremely low. Therefore, these patients should be screened for HBV serology and prophylactic treatment should be given when necessary for HBVr.Öğe Investigation of hepatitis B virus prevalence and reactivation frequency in malignancy patients administering chemotherapy(2021) Cengiz, Muhammet; Seckin, Yuksel; Cagin, Yasir Furkan; Cengiz, Ayse NuransoyAim: This study aimed to investigate the frequency at which physicians test hepatitis B virus (HBV) serology before treatment and the rate of hepatitis B virus reactivation (HBVr) after treatment in patients undergoing chemotherapy (CT) due to a solid organ malignancy (SOM) or hematological malignancy (HM). Materials and Methods: Baseline clinical feature, HBV serology, and liver function test data for 1275 patients ? 18 years of age who underwent CT for the first time due to various SOMs and HMs from 2015-2017 were obtained from the database and retrospectively analyzed. HBV serology was studied in 296 (201 HM, 95 SOM) of the 1275 patients retrieved from the database. Results: The prevalence of HBV was 9.5% (121 patients). Only 49 (40.4%) HBV-positive patients had HBV DNA. Of those, 72 (59.5%) underwent prophylactic antiviral therapy. HBVr was detected in only 3 patients (1.5%), and all of those patients had HMs and were recommended oral antiviral therapy but did not. Conclusion: In patients with SOMs, the screening rates of HBV serology, as well as prophylaxis and follow-up HMs were extremely low. Therefore, these patients should be screened for HBV serology and prophylactic treatment should be given when necessary for HBVr.Öğe Lighter Ingestion as an Uncommon Cause of Severe Vomiting in a Schizophrenia Patient(Hindawi Ltd, 2016) Atayan, Yahya; Cagin, Yasir Furkan; Erdogan, Mehmet Ali; Bilgic, Yilmaz; Bestas, Remzi; Harputluoglu, Murat; Seckin, YukselBackground. Foreign bodies in the gastrointestinal tract are important morbid and mortal clinical conditions. Particularly, emergency treatment is required for cutting and drilling bodies. The majority of ingested foreign bodies (80-90%) leave gastrointestinal tract without creating problems. In 10-20% of cases, intervention is absolutely required. Less than 1% of cases need surgery. In this paper, we present a schizophrenia patient who swallowed multiple lighters. Case. A 21-year-old male schizophrenic patient who uses psychotic drugs presented to the emergency department with the complaints of abdominal pain, severe vomiting, and inability to swallow for a week. His physical examination revealed epigastric tenderness. A plain radiograph of the abdomen revealed multiple tiny metallic densities. Gastroscopy was performed. The lighters were not allowing the passage, and some of them had penetrated the gastric mucosa, and bezoars were observed. One lighter was extracted with the help of the polypectomy snare. Other lighters as a bezoar were removed by surgery. Conclusion. Excessive vomiting of swallowed foreign bodies in the etiology of psychotic patients should be kept in mind. Endoscopic therapy can be performed in the early stages in these patients, but in the late stage surgery is inevitable.Öğe Long-Term Effects of Antiviral Administration on Esophageal Varice Dimensions in Cirrhotic Cases(Wiley-Blackwell, 2013) Aladag, Murat; Harputluoglu, Murat; Aladag, Hulya; Seckin, Yuksel[Abstract Not Available]Öğe Long-term efficacy of combination therapy with PEG-IFN and entecavir on HBsAg loss and anti-HBs seroconversion in patients with chronic active hepatitis(Wiley-Blackwell, 2012) Aladag, Murat; Aladag, Hulya; Harputluoglu, Murat; Seckin, Yuksel; Bilgic, Yilmaz; Karincaoglu, Melih[Abstract Not Available]Öğe Methylprednisolone prevents bacterial translocation in thioacetamide-induced liver failure in rats(Aves, 2017) Harputluoglu, Murat Muhsin Muhip; Temel, Ismail; Demirel, Ulvi; Seckin, Yuksel; Aladag, Murat; Otlu, Baris; Karadag, NeseBackground/Aims: Steroids have been shown to prevent intestinal oxidative stress. We investigated the effects of methylprednisolone on intestinal oxidative damage and bacterial translocation in thioacetamide-induced liver failure in rats. Materials and Methods: Group 1 (n=8) was the control group. In group 2 (n=8), the thioacetamide group, rats received 300 mg/kg intraperitoneal thioacetamide daily for 2 days. In group 3 (n=8), the thioacetami de+methylprednisolone group, treatment with methylprednisolone (30 mg/kg intraperitoneal) was commenced 48 h before the first dose of thioacetamide. In group 4 (n=8), the methylprednisolone group, the rats received only methylprednisolone (30 mg/kg intraperitoneal). Results: Serious hepatic and intestinal oxidative damage and high bacterial translocation frequencies were observed in the thioacetamide group compared with those of the controls. Bacterial translocation frequency in the thioacetamide+methylprednisolone group was significantly lower than that in the thioacetamide group (p<0.05). Intestinal thiobarbituric acid-reactive substances and myeloperoxidase levels and tissue damage scores for the intestines in the thioacetamide+methylprednisolone group were lower than those in the thioacetamide group (p<0.01, p<0.01, and p<0.0001, respectively). Conclusion: Our findings suggest that methylprednisolone reduces bacterial translocation by preventing intestinal oxidative damage in this model of acute liver failure in rats.Öğe A mitochondrial neurogastrointestinal encephalomyopathy with intestinal pseudo-obstruction resulted from a novel splice site mutation(Lippincott Williams & Wilkins, 2019) Erdogan, Mehmet A.; Seckin, Yuksel; Harputluoglu, Muhsin M.; Karincaoglu, Melih; Aladag, Murat; Caliskan, Ali R.; Bilgic, YilmazMitochondrial neurogastrointestinal encephalopathy (MNGIE) is an autosomal recessive disorder characterized by gastrointestinal dysmotility, cachexia, ptosis, peripheral neuropathy and leukoencephalopathy. The diagnosis is often not made until 5-10 years after the onset of symptoms. MNGIE is caused by mutations in thymidine phosphorylase gene TYMP. Here, we present a 19-year-old boy with MNGIE who had a chronic intestinal pseudo-obstruction, and we describe his family history. Genetic analysis revealed a novel homozygous c.765+1G>C intronic mutation which is expected to disrupt splicing of TYMP in the patient. Family screening revealed that the brother was also affected and the mother was a carrier. MNGIE should be considered and genetic testing instigated if individuals with cachexia have neuromuscular complaints or symptoms of chronic intestinal pseudo-obstruction. Copyright (c) 2018 Wolters Kluwer Health, Inc. All rights reserved.Öğe An outbreak associated with multidrug-resistant Pseudomonas aeruginosa contamination of duodenoscopes and an automated endoscope reprocessor(Allied Acad, 2017) Yetkin, Funda; Ersoy, Yasemin; Kuzucu, Cigdem; Otlu, Baris; Parmaksiz, Nalan; Seckin, YukselBackground: Duodenoscopes are semi-critical devices used for endoscopic retrograde cholangiopancreatography (ERCP). Disinfection of these instruments is usually based on high-level disinfection procedures with a manual or automated endoscope reprocessor (AER). Duodenoscopes and AER are reported very rarely as a source of infection and outbreaks. Aim: To investigate an outbreak caused by Pseudomonas aeruginosa in a Gastroenterology Department and ERCP unit in a university hospital and its underlying risk factors. Method: Three patients in the gastroenterology unit were diagnosed as infected by multidrug-resistant P. aeruginosa and a case control study was conducted for detection of the risk factors. Our infection control team commenced active epidemiological surveillance to determine the cause of these infections. Clonal relationship of the strains was investigated by pulsed field gel electrophoresis (PFGE). Results: Eight patients were affected in the gastroenterology unit during the period November 2007-February 2008. The case-control analysis confirmed that undergoing ERCP was significantly associated with isolation of P. aeruginosa (P=0.0001) in this unit. Six patients' isolates and seven environmental isolates had an indistinguishable PFGE profile, confirming cross-transmission. The healthcare worker implemented infection control measures to resolve the outbreak and no further cases occurred. Conclusions: This outbreak resulted from failure of AER and inadequate high level disinfection procedures. AERs can cause contamination of duodenoscopes and can be related P. aeruginosa outbreaks. Reuse of ancillary materials of ERCP play a critical role in outbreak development.
