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    Clinical features and outcomes of gastrointestinal symptoms in patients with COVID-19
    (2021) Koç, Süleyman; Bulur, Oktay
    COVID-19 infected patients clinically can be asymptomatic or symptomatic. Clinical course in symptomatic patients may be present with mild, moderate, or severe symp- toms. The coronavirus can affect multi-organ systems. The respiratory system is the most frequent target for the virus. Besides, gastrointestinal involvement may occur in occasional patients. We aimed to determine the clinical features and outcomes of gastrointestinal symptoms in patients with COVID-19. We retrospectively investigated 188 COVID-19 patients—patients clinical and demographic information obtained from the hospital database. Patients were categorized according to the clinical manage- ment guide released by the Republic of Turkey Ministry of Health. The mean age of the patients was 55.95 years (±17.62). 118 (62.8%) of the patients were men, and 70 (37.2%) of women. 118 (62.8%) patients were symptomatic, and 70 (37.2%) patients were asymptomatic. Among symptomatic patients, 56(47.4%) patients have isolated non-gastrointestinal symptoms, 52 (44.06%) patients have both (non-gastrointestinal, and gastrointestinal) symptoms, and 10 (8.4%) patients have isolated gastrointestinal symptoms. The distribution of the symptoms in 118 symptomatic patients was: 61 (32.5 %) patients have a fever, 84 (44.7 %) patients have a cough, 72 (38.3%) patients have dyspnea. The spectrum of gastrointestinal symptoms was as follows: 11 (5.9%) patients have diarrhea, 18 (9.6% ) patients have abdominal pain, 24 (12.8%) patients have nausea, 14 (7.5%) patients have vomiting, 38 (18.7%) patients have anorexia, 2 (2.1%) patients have constipation. However, COVID-19 infection present commonly with respiratory and musculoskeletal symptoms; it is important to be aware of the varied clinical presentations in COVID-19, including isolated gastrointestinal symptoms. This will allow increasing the timely detectability of infected patients and more effective contact control measures.
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    Comparison of APACHE II and Modified Charlson Index in Mortality Prediction in Patients at Medical Intensive Care Unit
    (2022) Bulur, Oktay; Efe, Fatma Kaplan; Iynem, Hatice Kevser; Koç, Süleyman; Beyan, Esin
    Acute Physiology and Chronic Health Evaluation II (APACHE II) and Modified Charlson Index (MCI) are used to predict the fatality in intensive care units (ICU). We aimed to investigate the difference between these scores in the prediction of fatality in the medical intensive care unit. Our study is important because in our literature overview, this study is one of the rare studies that compares these scoring systems. 108 ICU patients included. In all subjects APACHE II and MCI performed. Procalcitonin, C-reactive protein(CRP) levels of patients were recorded. Patients were then grouped according to mechanically ventilated or not; mortality happened or not. Statistically significance found in age(p<0.045), mechanical ventilation, procalcitonin, CRP and MCI (p<0.001) about mortality . MCI sensitivity and specifity were higher than APACHE II in %95 confidance interval. Area under curve in ROC analysis was CRP (0.728), Procalcitonin (0.719), MCI (0.686), APACHE II (0.665) respectively. Our study demonstrates that the Modified Charlson Index combined with procalcitonin and CRP can be used for predicting mortality in medical ICU as well as APACHE II 
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    Prognostic Significance of Neutrophil-Lymphocyte ratioinCOVID-19 Infection
    (Sivas Cumhuriyet University, 2022) Yıldırım, Merve; Bulur, Oktay
    Objective: Serum markers, radiological signs and clinical findings may help guide the assessmentof the prognosis of COVID -19 infection.Neutrophil-lymphocyte ratio is a cheap and easily attainable inflammatory marker.This study aims to investigate whether neutrophil-lymphocyte ratio is associated with the clinical course of the disease in COVID-19 patients with the non-severe diseaseMaterials and Methods: We retrospectively analyzed the results of 189 patients who were followed-up at the pandemic clinic of Erciyes University, Medical Faculty Hospital. Patients were categorized according to the criteria released by the Republic of Turkey Ministry of Health. That guide classifies the patients as mild-moderate and severe.Patients over 18 years of age who were treated with COVID-19 and whose symptoms were not severe were included in this study.Patients who have missing data were excluded from this study. Results: The findings showed that there was no significant difference in hospitalized patients concerning neutrophil-lymphocyte ratiolevels, white blood cell count, neutrophil count, lymphocyte count in mild or moderate COVID-19 infected patients at admission and discharge. There was a significant difference in CRP levels between admission and discharge however patients did not progress to a clinical deterioration on the follow-up.Conclusion: Neutrophil-lymphocyte ratiolevels did not change significantly between admission and discharge in mild-moderate patients. In light of previous studies reporting that neutrophil-lymphocyte ratiolevels are high in patients with severe COVID-19, the present study suggest that neutrophil-lymphocyte ratio levels are a proper marker for predicting the tendency to severe COVID -19 disease in the follow-up of the patients.
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    The Invisible Part of “ICEBERG”:Extraintestinal Findings and Celiac Disease
    (2022) Karakay, Serdar; Karadağ, İbrahim; Yildirim, Aslihan Mete; Bulur, Oktay; Uzman, Metin; Beyan, Esin
    Aim: Clinical manifestations of celiac disease (CD) can be quite different and varying. The number of CDs presenting with atypical symptoms is increasing day by day. Hence, we aimed to determine how many patients with CD were atypical celiac through examining their admission complaints, clinical characteristics, laboratory results, endoscopic findings, and pathological findings. Material and Methods: Eighty-nine patients with CD aged over 18 years who were followed-up in Ankara Kecioren Training and Research Hospital Internal Medicine Clinic between 2007 and 2014 were included in the study. The files of the patients were reviewed retrospectively. Sex, age, hospital admission complaints, clinical characteristics, laboratory results, endoscopy findings, and pathology results of the patients were recorded. Results: The median age of the patients in the study was 36, and 68.5% of them were female. The most common symptoms of the patients were fatigue (49.4%), anorexia (33.7%), and dyspepsia (22.5%), while diarrhea (19.1%), which is among the classical symptoms, was less common. 7.8% of the patients had no complaints at the time of admission, whereas 47.1% of them had only extraintestinal symptoms. At admission, 47% of the patients had anemia, 73.4% had iron deficiency, and 55.4% of them had vitamin B12 deficiency. When hemoglobin, ferritin, and vitamin B12 levels were compared before and after a gluten-free diet, a significant increase was determined. Transaminase elevation was detected in 25.3% of our patients at the time of diagnosis. When pre-treatment and post-treatment values were compared, a significant decrease was determined in those with high transaminase levels. In the pre-treatment serological test results of the patients, Ig A EMA positivity was the most common finding with a rate of 90.2%, followed by IgG EMA with 88.9%. In terms of pre-treatment endoscopy findings, 50.2% of our patients had normal appearance, 25.4% had a mosaic pattern, 12.6% had effacement of the duodenal folds, 12.6% had a nodular appearance, and 9.5% had a scalloping of the duodenal folds. When the pathology results of our patients were examined, 83.4% of them were at the advanced stage and with Marsh Type 3. Conclusion: CD may present with atypical complaints such as extraintestinal findings, as in more than half of the patients in this study. Celiac disease should be taken into consideration, particularly in conditions such as iron deficiency, osteoporosis, and transaminase elevations, which are prevalent in the community. The prevalence of CD in our country is estimated to be around 1-2%; however, it is considered that there are more asymptomatic patients with atypical celiac disease. When diagnosing CD, the most crucial step is to consider the potential presence of CD during pre-diagnoses. Thus, CD should be included in the differential diagnosis, specifically in patients presenting with atypical symptoms.
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    The relationship between severity of gastric inflammation due to Helicobacter pylori and colorectal malignancies
    (Sivas Cumhuriyet University, 2021) Bulur, Oktay; Aksoy, Evrim Kahramanoğlu; Şimşek, Gülçin Güler; Eser, Murat; Lülleci, Zeliha Asiltürk; Dal, Kürşat; Uzman, Metin
    Objective: Several factors play role in colorectal carcinogenesis. Among these factors, helicobacter pylori infection is supposed to be one of the causative factors. Previous studies were focused on investigation of the relationship between helicobacter pylori existence and colon carcinomas by particular serological diagnostic tests. The aim of our study was to determine the effect of the helicobacter pylori infection and the severity of inflammation related to this infection on the colon carcinomas and non carcinoma colon mass lesions(tubular adenoma, tubulovillous adenoma, hyperplastic polyp).Method: A retrospective study was conducted at Kecioren Teaching - Research Hospital between 2010 to 2018. The files of 657 patients who underwent colonoscopy and were diagnosed as colon benign or malign mass lesions were examined retrospectively from the hospital database. Two hundred five patients who had undergone both upper gastrointestinal endoscopy and colonoscopies were included in the study. The presence and severity of inflammation due to helicobacter pylori were evaluated by histopathological examination of biopsies taken during upper gastrointestinal endoscopy. The severity of H. pylori inflammation was graded according to the Sydney classificationResults: In the comparison of colon carcinoma with other colon mass lesions group, there was no statistical significance in terms of gender (P= 0.094) and H. pylori serology (P= 0.998). However, the degree of inflammation was significantly high in patients with colon carcinoma than other colon mass lesions (P< 0.001).Conclusions: The fact that the severity of helicobacter pylori inflammation is higher in patients with colon carcinoma than patients with non-carcinoma colonic mass lesions suggests that inflammation due to helicobacter pylori may be more important than the presence of helicobacter pylori in the carcinogenesis of colon cancer.