The Silent Face of Chronic Hepatitis B: Biopsy-Supported Fibrosis Detection and the Reliability of Non-Invasive Scores (FIB-4, APRI) in Inactive, Gray Zone, and Immune-Tolerant Cases - Article abstract #951084

Background: This study aimed to estimate the correlation between body mass index, waist circumference and neck circumference and cardiovascular risk factors in healthy adult men and women with no history of any disease or chronic drug intake from Diyarbakır and Dicle University medical faculties. Materials and methods: The study included 199 subjects, 113 males (mean age 36.5 ± 11.3 years) and 86 females (mean age 33.8 ± 11.7 years) aged between 20 and 73 years. Age, height, weight, blood pressure, pulse rate, anthropometric methods; waist circumference (WC), body mass index (BMI), neck circumference (NC), blood glucose and insulin levels were determined. Insulin resistance was evaluated with the Homeostasis model assessment (HOMA-IR) formula. Total-cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol levels were measured. Pearson correlation and independent t-test were applied to the obtained study parameters. Results: 47.7% of women were obese, 1.2% were morbidly obese and 59.3% of men were obese. Waist circumference correlated with systolic blood pressure (r=0.426, p<0.001), diastolic blood pressure (r=0.414, p<0.001), total cholesterol (r=0.450, p<0.001), triglycerides (r=0.556, p<0.001) and LDL-cholesterol (i=0.486, p<0.001), and a negative correlation was found between waist circumference and HDL-cholesterol (r=0.261, p<0.001). In women, the relationship between BMI and HOMA-IR (r-0.415, p<0.001) was stronger than the relationship between waist circumference and HOMA-IR (r=0.333, p=0.02). In men, we found a positive correlation between waist circumference and HOMA-IR (r=0.271, p=0.04). In men, we found no correlation between BMI and HOMA-IR. Neck circumference was correlated with waist circumference (i=0.732), total cholesterol (r=0.534), triglycerides (r=0.365), LDL cholesterol (i=0.406), BMI (r=0.568), systolic blood pressure (r=0.200), diastolic blood pressure (r=0. 290), and glucose (r=0.280) (p < 0.001). Conclusions: Waist circumference was more tightly correlated with metabolic parameters. Waist circumference may better reflect the risk of cardiovascular disease than BMI. Neck circumference measurement, a new obesity indicator, can also be used as an obesity assessment method. Keywords: Cardiovascular risk factors, body mass index, waist circumference, neck circumference

Background/Objectives: Ustekinumab (UST) and upadacitinib (UPA) are molecules that have been used in patients with ulcerative colitis (UC) since 2019 and 2022, respectively. Both agents are generally preferred for biologically experienced UC patients. However, the number of head-to-head studies comparing the efficacy and adverse events of UST and UPA in this patient group is limited. Methods: This was a retrospective cohort study evaluating the efficacy and safety of UST (n = 57) and UPA (n = 32) in biologically experienced UC patients during the induction and 24-week maintenance treatment periods. Most patients in both groups had received prior anti-TNF treatment (98.2% and 96.9%, respectively). Clinical response and remission rates were determined based on the partial Mayo score (PMS). Additionally, patients’ pre-treatment laboratory parameters were compared with their results at week 24. Results: During the induction phase, clinical response and remission were achieved in 84.2% and 43.9% of the UST group and 93.8% and 50% of the UPA group, respectively (OR [95% CI] = 2.81 [0.57–6.87] and 1.28 [0.54–3.05]). At week 24, the clinical response and remission rates in the UST and UPA groups were similar (77.1% vs. 80% and 58.3% vs. 63.3%, respectively). No statistically significant difference was found between the groups (p > 0.05). Both UST and UPA provided a marked reduction in fecal calprotectin and CRP levels. Regarding safety, UPA treatment led to increased total, LDL, and HDL cholesterol levels, whereas UST did not. In both groups, glucose; HbA1c; and thyroid, renal, and liver functions remained stable. No serious adverse events were observed in either group. At week 24, treatment continuation rates were 68.4% (n = 39) for UST and 78.2% (n = 25) for UPA (OR = 0.61 [0.22–1.66]). Conclusions: In biologically experienced ulcerative colitis, both UST and UPA are effective and safe treatment options. This study did not statistically demonstrate the superiority of UPA over UST. Given the preliminary nature and limited patient numbers of this investigation, our findings require confirmation through future multicenter, large-scale, and long-term prospective studies.

Background and Objectives: Acute pancreatitis (AP) is an acute inflammatory disease ranging from mild, self-limiting forms to severe presentations associated with high morbidity and mortality. Early prognostic assessment is crucial for guiding clinical management. This study aimed to evaluate the prognostic value of the red cell distribution width-to-albumin ratio (RDW/Alb, RAR) in relation to clinically relevant outcomes, including intensive care unit (ICU) admission and in-hospital mortality, in patients with AP. Materials and Methods: This retrospective study included 282 patients diagnosed with AP who were hospitalized at Mersin University Hospital between January 2019 and February 2024. Clinical, laboratory, and radiological data were retrospectively analyzed. The predictive performance of RAR was evaluated and compared with established clinical scoring systems, including bedside index for severity in acute pancreatitis (BISAP), systemic inflammatory response syndrome (SIRS), harmless acute pancreatitis score (HAPS), and pancreatitis activity scoring system (PASS). Results: The median RDW-to-albumin ratio (RAR) was 3.9 (range: 2.6–36.7). Receiver operating characteristic (ROC) curve analysis demonstrated that RAR showed good predictive performance for ICU admission (Area Under the Curve (AUC): 0.781; p < 0.001; optimal cut-off: 4.15) and high predictive performance for in-hospital mortality (AUC: 0.927; p < 0.001; optimal cut-off: 5.26). RAR exhibited limited but statistically significant discriminatory performance when compared with the BISAP score (AUC: 0.591; p = 0.017), whereas no significant predictive performance was observed in relation to PASS, HAPS, or SIRS scores. Conclusions: Within the context of this retrospective cohort, RAR is a simple, inexpensive, and readily available biomarker that may be associated with ICU admission and in-hospital mortality in patients with AP. Given the absence of standard severity endpoints such as persistent organ failure or pancreatic necrosis, these findings should not be interpreted as evidence of conventional disease severity prediction but rather as hypothesis-generating observations that warrant validation in larger prospective studies.

Background: Post-ERCP pancreatitis (PEP) remains the most common and clinically relevant adverse event following endoscopic retrograde cholangiopancreatography (ERCP). The impact of periampullary duodenal diverticulum and advanced cannulation techniques—particularly needle–knife precut sphincterotomy and transpancreatic septotomy (TPS)—on PEP risk remains debated. This study aimed to evaluate the association of these factors with PEP development in a large tertiary-center cohort. Methods: This retrospective study included 1226 patients who underwent ERCP between January 2018 and October 2022. Demographic, clinical, and procedural variables were recorded. Outcomes included PEP, hyperamylasemia, bleeding, and perforation. Univariable analyses were followed by multivariable logistic regression to identify independent predictors of PEP. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Results: PEP occurred in 17.3% of the cohort. Needle–knife precut sphincterotomy and transpancreatic septotomy were frequently used advanced cannulation techniques and were both associated with an increased prevalence of PEP, with PEP occurring in 30.3% of patients undergoing needle–knife precut sphincterotomy and 56.9% of those undergoing transpancreatic septotomy. In the multivariable model, needle–knife precut independently increased PEP risk by 2.45-fold (aOR 2.45; 95% CI 1.78–3.36; p < 0.001), whereas TPS demonstrated the strongest association, increasing the risk nearly fivefold (aOR 4.92; 95% CI 2.98–8.11; p < 0.001). Female sex showed a nonsignificant trend toward increased PEP risk (aOR 1.28; 95% CI 0.96–1.69; p = 0.08). Periampullary duodenal diverticulum, pancreatic duct stenting, comorbidities, and age were not independently associated with PEP development (p > 0.05 for all). Conclusions: Needle–knife precut sphincterotomy and transpancreatic septotomy were independent predictors of PEP, with the highest risk observed for transpancreatic septotomy, whereas periampullary diverticulum and pancreatic duct stenting were not associated with increased risk.

Giriş ve Amaç: Transpankreatik sfinkterotomi, endoskopik retrograd kolanjiyopankreatografi sırasında biliyer kanülasyonun başarısız olduğu durumlarda, ortak safra kanalına erişim sağlamak amacıyla uygulanan ileri bir kanülasyon tekniğidir. Bu prosedür, sfinkterotom aracılığıyla pankreas ve safra kanalı arasındaki septumun kesilmesini içerir. Çalışmamızda, transpankreatik sfinkterotominin etkinlik ve güvenliğini, post-endoskopik retrograd kolanjiyopankreatografi pankreatiti ile diğer olası komplikasyonlar açısından klinik sonuçlarını değerlendirdik. Gereç ve Yöntem: 1 Şubat 2020 – 1 Eylül 2023 tarihleri arasında Mersin Üniversitesi Hastanesi'nde gerçekleştirilen endoskopik retrograd kolanjiyopankreatografi işlemleri retrospektif olarak incelendi. Çalışma grubu, ardışık olarak transpankreatik sfinkterotomi uygulanan 66 hasta ile 67 kişilik kontrol grubundan oluşmaktaydı. Veriler, hasta dosyaları ve hastane kayıtlarından elde edildi. Hastaların demografik özellikleri, biliyer kanülasyon başarı oranı, endoskopik retrograd kolanjiyopankreatografi sırasında gerçekleştirilen işlemler, işlem sonrası pankreatit gelişimi, diğer komplikasyonlar ve ilişkili risk faktörleri değerlendirildi. Bulgular: Transpankreatik sfinkterotomi grubunda 29 hastada (%43.9) post-endoskopik retrograd kolanjiyopankreatografi pankreatiti gelişirken, kontrol grubunda bu oran 10 hastada (%14.9) saptanmış ve fark istatistiksel olarak anlamlı bulunmuştur (p < 0.001). Hiperamilazemi oranı her iki grupta da %23.9 olup transpankreatik sfinkterotomi uygulamasıyla anlamlı ilişki göstermemiştir (p = 0.80). Kanama insidansı açısından da gruplar arasında fark izlenmemiştir (p = 0.55). Transpankreatik sfinkterotomi uygulaması ile diabetes mellitus, hipertansiyon, hiperlipidemi, kardiyovasküler hastalık, kronik böbrek yetmezliği, kronik obstrüktif akciğer hastalığı ve kolesistektomi öyküsü arasında anlamlı bir ilişki saptanmamıştır (sırasıyla p = 0.37; 0.06; 0.99; 0.39; 0.32; 0.15; 0.12). Ortalama hastanede yatış süresi transpankreatik sfinkterotomi grubunda 6.9 ± 3.8 gün, kontrol grubunda ise 3.7 ± 2.3 gün olup fark anlamlıdır (p = 0.008). Ayrıca transpankreatik sfinkterotomi uygulanan hastalarda post-prosedürel karın ağrısı daha şiddetli izlenmiştir (p < 0.001). Sonuç: Transpankreatik sfinkterotomi yöntemi kanülasyon başarısını artıran bir yöntemdir. Diğer taraftan transpankreatik sfinkterotomi yönteminin faydalı ancak post endoskopik retrograd kolanjiyopankreatografi pankreatiti açısından yeterince güvenli olmadığını düşünüyoruz.