Celiac disease and H. pylori existence in the adult population and its effects on anemia incidence

OBJECTIVE

Anemia is a common extraintestinal symptom of celiac disease; however, inflammation and Helicobacter pylori (HP) infection can also induce anemia. Anemia is associated with both H. pylori infection and celiac disease, which can significantly impact public health. In our study, we aimed to determine the impact of H. pylori infection on anemia in celiac disease adults.

PATIENTS AND METHODS

In this study, 150 celiac disease patients with endoscopy results were retrospectively analyzed. Patients' gender, age, Oberhuber-Marsh scores, presence of H. pylori, presence of anemia, serum tissue transglutaminase (TTG), immunoglobulin (Ig) A and IgG levels, anti-gliadin antibody (AGA) IgA and IgG levels, Endomysial Antibody (EMA) IgA and IgG levels, serum hemoglobin, C-reactive peptide (CRP), ferritin, vitamin B12, folate, total protein, and albumin levels, serum neutrophil, monocyte, lymphocyte, eosinophil, and platelet counts, and mean corpuscular volume, mean platelet volume and platelet distribution width variables were examined. The patients were divided into HP-negative and HP-positive groups, and statistical analysis was performed between the two groups.

RESULTS

Among all patients, HP infection was seen in 24 (16%) patients. There was no difference between HP-positive and HP-negative groups in terms of gender, age, Marsh scores, serologic test levels, platelet, lymphocyte, neutrophil counts, CRP, vitamin B12, and folate levels. The anemia rate of HP-negative patients was 32.54%, HP-positive patients' rate was found to be significantly higher at 79.17% (p<0.001). The ferritin median of HP-negative patients was 41.49 (1-1441) and 13 (2.4-22) for HP-positive patients (p<0.001).

CONCLUSIONS

Anemia rates were 6.8-fold higher in HP-positive celiac patients. Celiac disease patients with anemia should have HP infection on their list of possible causes, especially in patients with refractory anemia.

A new index for predicting malignant causes in patients with extrahepatic biliary obstruction: the hemoglobin, albumin, lymphocyte, and platelet (HALP) score

OBJECTIVE

The study aimed to investigate whether the pre-procedural hemoglobin, albumin, lymphocyte, and platelet (HALP) scores can distinguish between benign and malignant causes of obstruction in patients who undergo endoscopic retrograde cholangiopancreatography (ERCP) for extrahepatic biliary obstruction (EBO).

PATIENTS AND METHODS

The HALP scores of the patients were calculated according to the values before ERCP. The patients were divided into two groups as malignant and benign according to their diagnosis after ERCP. The HALP scores, demographic characteristics, and some laboratory data of the groups were compared. The cut-off values of the HALP scores were found to detect malignant obstructive causes using the receiver operating characteristic (ROC) curve analysis.

RESULTS

A total of 295 patients had benign and 50 had malignant causes of obstruction among the total of 345 patients. The HALP score was found to be lower in the patient group with malignant biliary obstruction (p = 0.013). The ROC curve analysis was used to determine the diagnostic efficiency, and an area under the curve (AUC) of 0.610 was obtained (0.526-0.693, 95% CI) (p = 0.013). For the HALP score, the sensitivity was found to be 82.4% and the specificity was 30% when a cut-off value of <12.54 was used, and the sensitivity was 61.4% and specificity was 52% when the cut-off value was <21.25.

CONCLUSIONS

The study showed that a low HALP score can distinguish malignant causes in patients with EBO. We think that the HALP score, which is a low-cost index that can be easily calculated with simple tests, can be used in this patient population because it may allow early diagnosis of malignant causes in patients with EBO.

Risk factors for post-ERCP pancreatitis: it depends on the ERCP indication

BACKGROUND AND AIMS

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive modality, and has a high risk of causing post-ERCP pancreatitis (PEP). Risk factors of PEP have been investigated and conflicting results are present for most risk factors. The aim of this study was to evaluate the risk factors for PEP and to determine whether the risk factors differ due to the ERCP indication.

PATIENTS AND METHODS

A retrospective study was conducted which included 666 patients with 968 ERCP procedures. Some risk factors were evaluated for PEP, and they were also evaluated separately for patients with bile duct stones and patients who underwent ERCP for other reasons than bile duct stones.

RESULTS

In patients with bile duct stones detected on ERCP ; female gender, lower diameter of the common bile duct, placing a biliary plastic stent and not having a cholecystectomy history were risk factors for PEP, whereas in patients without bile duct stones the only risk factor for PEP was not having a prior endoscopic sphincterotomy.

CONCLUSIONS

Our study revealed that PEP risk factors depend on the indication of ERCP. To the best of our knowledge our study is the first study defining cholecystectomy as a protective factor for PEP in patients with bile duct stones and endoscopic sphincterotomy history as a protective factor for PEP in patients without bile duct stones. Our study also showed that female gender, lower diameter of the common bile duct and placing a plastic biliary stent were risk factors for PEP in patients with bile duct stones.

Lithiazis in the periurethral gland of a woman

We present a very rare case of stone formation in the periurethral gland of a 49-year-old woman who was referred to our hospital with suspicion of a malignant or granulomatous soft-tissue lesion in the paraurethral area. The lesion was excised and the histopathological examination revealed cystic dilatation and squamous metaplasia in the lining of the glandular structure and surrounding lymphocyte infiltration. The scanning electron microscope examination of the stone revealed egg shell-like stratified concentric calcifications. The chemical composition revealed by the X-ray diffraction technique was a mixture of calcium oxalate and phosphate similar both at the outer and inner layers.

[Prostatic calculi: silent stones]

INTRODUCTION AND OBJECTIVES

Prostate stones are frequently encountered during transurethral resection of the prostate in urology practice. We aimed to demonstrate the physical and chemical properties of prostate stones. We also aimed to determine possible relationship between inflammation of prostate gland and prostate stones.

METHODS

The consecutive patients (excluding subjects with PSA>or=4ng/ml and urolithiasis), who underwent TURP operation and who were observed to have prostatic calculi during TURP, were included in the study. The prostatic stones obtained from each patient during TURP were analysed for chemical composition and observed under electron microscopy (SEM) for structure and surface morphology. The pathological specimens were assessed by the uropathologist for the final diagnosis and existence and degree of inflammation.

RESULTS

Five patients were included in the study. From each patient at least three (range 3-8) samples of stones (diameter varying from 1mm up to 5mm) were obtained. The stones were made of mixed composition of calcium phosphate and calcium carbonate. The stones were found to have lobular surface made up of small spheres under SEM. Histopathological examination of the TURP specimens revealed being prostatic hyperplasia accompanied with inflammation of mild to severe degree.

CONCLUSIONS

Prostatic stones are concentrically precipitated calcium stones within the prostatic ductuli with granular grape like morphology. Histopathological inflammation seems to be associated with these prostatic calculi.

Sexual function in women with urinary incontinence

To date limited data exists that addresses the impact of urinary incontinence on sexual function. In the present study, we assessed sexual functions in patients with urinary incontinence and compared with healthy continent subjects by means of Female Sexual Function Index (FSFI) questionnaire. A total of 21 premenopausal incontinent women (three stress incontinence, nine overactive bladder and nine mixed incontinence) were enrolled in the study, and 18 healthy continent subjects served as controls. All subjects were asked to complete FSFI questionnaire and each FSFI domain scores including desire, arousal, lubrication, orgasm, satisfaction and pain were calculated. The mean scores in each domain were compared between the groups. Mean age of subjects with urinary incontinence and controls were 39.5+/-6.6 and 32.6+/-9.1 y, respectively. All domain scores were significantly lower in incontinent women except for pain. Among the incontinence types, no significant difference was determined in all domains of FSFI. Urinary incontinence significantly reduces sexual functions in premenopausal sexually active women.

Erectile dysfunction prevalence and sexual function status in patients with chronic obstructive pulmonary disease

PURPOSE

We determined sexual status and erectile dysfunction (ED) in outpatients with chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

Between October 2002 and June 2003 a total of 60 successive outpatients with COPD enrolled in the study with written informed consent. Patients completed International Index of Erectile Function (IIEF) and Duke Activity Status Index questionnaires. They also underwent physical examination including urogenital examination and pulmonary assessment with spirometry, 6-minute walk test and arterial blood sample. COPD severity was determined according to Global Initiative for Chronic Obstructive Lung Disease criteria.

RESULTS

After exclusion criteria 53 patients were assessed for statistical analysis. Mean patient age was 63.4 +/- 7.3 years. COPD severity in these patients was mild in 13.2%, moderate in 34%, severe in 49.1% and very severe in 3.8%. Nearly half of the patients (49%) had no comorbid disease for ED and the most common comorbid disease was hypertension (34%). According to the erectile function domain of IIEF 75.5% of patients were found to have ED with varying degrees (severe 28.3%, moderate 11.3%, mild to moderate 15.1% and mild 20.8%). Mean scores of all IIEF domains except sexual desire decreased with the increasing disease severity. A correlation was determined between severity and physical restrictions of COPD, and ED severity.

CONCLUSIONS

The limitation of physical activity due to COPD also diminishes the sexual function of patients. This point must be kept in mind in the evaluation of patients with COPD.