Interstitial pneumonitis is a rare but potentially fatal side effect occurring from 2 weeks to 16 weeks after the initiation of treatment with pegylated interferon alpha and ribavirin for chronic hepatitis C. Herein, we present a 68-year-old man with chronic hepatitis C virus infection who developed interstitial pneumonitis association with pegylated interferon after 36 weeks initiation of pegylated interferon-alpha and ribavirin therapy. He did not recover after discontinuation of pegylated interferon/ribavirin and improved by steroid therapy.
The endocannabinoid system can exert beneficial effects on gastrointestinal inflammation, and cannabinoid receptor-2 (CB2) agonists may represent a new therapeutic approach in inflammatory bowel disease (IBD). A functional CB2 Q63R polymorphism (rs35761398) in the CNR2 gene has been shown to affect the immunomodulating properties of the CB2 receptor. We sought to investigate whether the functional CB2 Q63R polymorphism (rs35761398) is associated with IBD susceptibility in a Turkish clinical sample.A total of 202 IBD patients, comprising 101 Crohn's disease (CD) patients and 101 ulcerative colitis (UC) patients, and 101 healthy controls were included in the study. The CB2 Q63R polymorphism was genotyped using real-time PCR.There were no significant differences in the genotype frequencies of the three study groups. The odds ratio of the minor Q allele for CD relative to the common R allele was not significant (OR =1.02, 95% CI =0.67-1.56, p=0.99). Similarly, the odds ratio of the minor Q allele for UC relative to the common R allele did not reach statistical significance (OR =1.10, 95% CI =0.72-1.68, p=0.75). Moreover, the genotype frequencies did not show any significant association with the disease extent in either CD (p= 0.71) or UC patients (p=0.59).These pilot findings suggest that CB2 Q63R polymorphism does not play a major role in genetic susceptibility to IBD or in its disease phenotypes among Turkish subjects.
Background: Patients with Crohn's disease experience major deterioration in work productivity and quality of life.We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36.Methods: Patients with Crohn's disease and initiated an anti-tumor necrosis factor treatment were included and followed up for 12 months in this observational study.Results: A total of 106 patients were included in this study, and 64.2% of the patients were males.Mean [± standard deviation] age was 36.8 [± 10.9] years.At baseline, mostly perianal fistulas [65.7%] were observed [n = 23].Intestinal stenosis was detected in 34.9% of the patients [n = 37], and most of the stenosis was located in the ileum [70.6%] followed by the colon [20.6%].Extraintestinal symptoms were observed in 24 patients [22.6%].Most frequent extraintestinal symptom was arthritis with 71.4% [n = 15].Mean time from first symptom to initiation of anti-tumor necrosis factor treatment was 6.3 [± 5.0] years.Improvements in work productivity and activity impairment scores throughout 12 months were -24.1% [P = .003]for work time missed, -18.0%[P = .006]for impairment at work, -8.5% [P = .160]for overall work impairment, and -17.0%[P < .001]for daily activity impairment.Similarly, significant improvements [P < .001]were detected in all components of the Inflammatory Bowel Disease Questionnaire when compared to baseline.Statistically significant improvements [P < .05]were detected for all components of Short-Form Health Survey-36 except for mental health [P = .095].Conclusion: Our study indicates the significant improvement in work productivity and activity impairment and quality of life of patients with Crohn's disease who receive long-term anti-tumor necrosis factor treatment.
Abstract Background Multi-layered convolutional neural networks are artificial intelligence (AI) algorithms that allow to process specific datasets. Endoscopic mayo score (EMS) is an endoscopic scoring tool for ulcerative colitis (UC) that is widely using for evaluating the disease activity to make a further treatment plan. EMS is an endoscopist-depended subjective tool that varies according to the physician’s experience. In this study, our aim was to create a high accuracy EMS diagnostic algorithm to minimize endoscopist-depended inconsistency and standardize the patient care. Methods We collected the endoscopic images of UC patients between December 2011 and July 2019 from electronic database of our gastroenterology institute. Images with insufficient bowel cleaning, artifact, retroflection images, terminal ileum images and pouch patients were excluded. Two blinded gastroenterologists evaluated and tagged the images according to the EMS. Images with a disagreement were excluded for a further evaluation. AI algorithm was performed with Python by using PyTorch library. The dataset was divided into two (85% was used for training and %15 was used for test). ResNet18 model was also used for training. Results A total of 19690 images of 572 patients from 1053 colonoscopies were identified for the study. The mean procedure number was 1.8 per patient and the mean image number was 18.7 for per colonoscopy. Four thousand and six hundred images without any disagreement between two gastroenterologists were included to the analysis. Two thousand eight hundred and thirteen (61.65%) images were tagged as EMS 0, 956 (20.66%) were tagged as EMS 1, 406 (8.77%) were tagged as EMS 2 and 413 (8.92%) were tagged as EMS 3. Accuracy was found 73.16% with a sensitivity of 773.2% and specifity of 92.9% in assessment of all EMS groups (Image 1). Also, the accuracy of severe mucosal disease diagnosis (EMS 0 and 1 vs EMS 2 and 3) was 96.3% with a sensitivity of 98.2% and specifity of 86.5% (Image 2) with a perfect reproductivity (к: 1.00). The performance of the remission diagnosis (EMS 0 vs EMS 1,2 and 3) was done with a 92% accuracy. Conclusion This is an ongoing study and the preliminary results of our EMS diagnosis algorithm was promising with a high accuracy. The accuracy and sensitivity would be improved by including more images and improving the algorithm. The use of AI in daily IBD practice can eliminate the subjectivity according to the endoscopist in diagnosis and assessing the disease severity for treatment decision.
Giris ve Amac: Gastroozofageal reflu, fonksiyonel dispepsi, ve peptik ulser sik karsilasilan kronik hastaliklardir. Bu hastaliklara ait yakinmalari n benzemesi ve birlikte bulunmasi en uygun tani ve tedavi yaklasimini belirlemekte zorluklara neden olabilir. Bu calismanin amaci birinci basamak saglik kuruluslarina ust gastrointestinal sistem sikayeti ile basvuran kadinlarda reflu semptomlarinin sikligi, agirligi ve turunu saptamak ve hastalarin ne kadarinda es zamanli gastroduodenal hastalik semptomu oldugunu belirlemektir. Yontem: Istanbul'un Gaziosmanpasa ve Kartal semtlerinde gezici saglik taramasi sirasinda gastrointestinal yakinmalar nedeniyle bir gunde basvuran butun kadinlar calismaya alindi. Ust gastrointestinal sistem sikayetlerinin varligi, sikligi ve agirligi 45 soruluk bir anketle sorgulandi. Veriler SPSS programi ile degerlendirildi. Bulgular: Yaslari 21 ile 87 arasinda degisen (ortalama 43.3±12.5) 346 kadin sorgulandi. En sik rastlanan sikayet aci regurjitasyonu idi. Bunu retrosternal yanma, retrosternal agri ve epigastrik siskinlik izledi. Olgularin %88.5'inde en az iki reflu semptomu (restrosternal agri, yanma, aci regurjitasyonu veya yutma guclugunden herhangi ikisi) vardi. En az iki reflu semptomu olanlarin %47.5'inde epigastrik agri, %59'unda epigastrik siskinlik vardi. Epigastrik agri; retrosternal yanma, retrosternal agri, yutma guclugu gibi aci regurjitasyonu disindaki reflu semptomlari ile iliskili bulundu. Epigastrik siskinlik ise aci regurjitasyonu, retrosternal agri, yutma guclugu gibi retrosternal yanma disinda kalan reflu semptomlari ile iliskili bulundu. Semptomlari ilac kullanacak kadar siddetli olanlarda epigastrik yakinmalar daha sik goruldu. Sonuc: Birinci basamak saglik kuruluslarinda ust gastrointestinal sistem sikayetleri ile basvuran kadinlarda en sik rastlanan semptomlar refluye aittir. Ancak olgulari n yarisinda semptomlar ulser ya da fonksiyonel dispepsi semptomlari ile ortusur. Hastalik gruplarini ayirmak icin anamnezden daha objektif araclara ihtiyac vardir.
