Autoimmune hepatitis is a rare inflammatory disease of the liver that is characterized by elevated liver enzymes. The hemoglobin, albumin, lymphocyte, and platelet score, which is derived from hemoglobin, serum albumin, circulating lymphocyte count, and platelet count, is also associated with inflammatory conditions. The aim was to examine the hemoglobin, albumin, lymphocyte, and platelet score of patients with autoimmune hepatitis and to compare it to that of healthy individuals in this retrospective analysis.

The Ankaferd Blood Stopper (ABS) proves effective in managing various bleedings, particularly in surgical and dental procedures. This study assesses ABS efficacy endoscopically by less-experienced endoscopists for non-variceal upper gastrointestinal bleeding (NVUGB). Between 2016 and 2021, our hospital’s Gastroenterology Department Endoscopy Unit conducted a retrospective data analysis of 653 patients who underwent endoscopy for NVUGB. The study included 202 patients who underwent endoscopic interventions performed by endoscopists with less than 3 years of experience. Based on the method used for endoscopic hemostasis, we classified those treated with ABS (either alone or as a second method) as group 1. In contrast, we classified patients treated with non-ABS hemostatic methods into Group 2. The study included 202 patients, with 96 (47.52%) in Group 1 and 106 (52.48%) in Group 2. All patients in Group 1 achieved bleeding control, while 4 patients in Group 2 initially did not achieve bleeding control; however, bleeding control was subsequently established following ABS administration. After 1 month of follow-up, mortality occurred in 3 out of 202 patients (1.48%), and all these cases were in Group 2. There is a significant difference in the need for blood transfusion between the groups (P < .001). Regarding the bleeding source, bulbus ulcer and gastric cancer were more prevalent in Group 2. On the other hand, although statistical significance was not reached in the comparison of rebleeding rates between groups, numerically, a higher incidence of recurrent bleeding was observed in Group 2 (Group 1: 3 [3.1%], Group 2: 8 [7.5%]; P = .167). Additionally, a similar relationship was noted among intensive care admissions (Group 1: 5 [5.2%]; Group 2: 7 [6.6%]; P = .675). In the group that used ABS, there were significantly higher rates of hypotension, tachycardia, syncope, and the need for transfusion than in the other group. In medical practice, this distinction often stems from the shared preference of clinicians to use ABS as a salvage method in cases of more severe bleeding. Considering all the findings, it is evident that using ABS through endoscopy in cases of NVUGIB significantly improves procedural success, irrespective of the endoscopist’s experience level.

Background/Aim: Proton pump inhibitors (PPIs), despite being the most prescribed medications today, have generated controversy due to their potential impact on bone metabolism. Numerous studies have emphasized the potential of prolonged PPI use to reduce bone mineral density, thereby increasing the risk of bone fractures among elderly and young individuals. However, the precise impact of PPI usage for 1 year or less on bone mineral density in young adults remains incompletely understood. Method: In this retrospective cohort study, we conducted a comprehensive review of all dual x-ray bone densitometric examinations conducted on females under 40 years old at our tertiary care center between 2010 and 2014. Among the initial 685 patients assessed, 117 samples met the predefined inclusion criteria and were consequently enrolled in the study. Subsequently, the enrolled cases were categorized into three distinct groups: Group 1 (n=46), which received PPI treatment for less than six months; Group 2 (n=31), which received PPIs for a duration ranging from 6 to 12 months; and Group 3 (n=40), comprising individuals with no history of PPI use, thus serving as the control group. Comprehensive baseline descriptive data, encompassing bone mineral density, t-scores, and z-scores, were meticulously compared among the three groups mentioned above. Results: The overall mean age of the study population was 32.84 (5.27) years, with an age range spanning from 20 to 40 years. No statistically significant differences in age were discerned among the three groups. Similarly, the groups exhibited no significant body mass index (BMI) variations. Noteworthy findings emerged after examining the effects of PPI usage on bone mineral density, z-scores, and t-scores across the three groups. Specifically, the data suggested that PPIs might influence t-scores (Group 1: -0.48 (0.77); Group 2: -1.25 (0.86); Group 3: -0.33 (0.78)), yielding an F-value of 13.28 for (2.116), signifying statistical significance at P<0.001. Moreover, the observed mean square error (MSE) was 64, while the effect size (eta²) was 0.19. Subsequent post-hoc Tukey tests indicated a significant distinction in the T-score of Group 2 compared to the other two groups. Furthermore, the analysis of z-scores (Group 1: 0.46 (0.79); Group 2: -1.27 (0.76); Group 3: -0.35 (0.86)) revealed a similar trend, with an F-value of 13.21 for (2.116) and a P-value below 0.001. The corresponding MSE was 0.65, and the eta² stood at 0.19. Additional post-hoc Tukey tests indicated that the Z-score of Group 2 significantly diverged from the other groups. However, it is noteworthy that both t and z-scores for Group 1 and Group 3 did not exhibit statistically significant differences. Conclusion: Prolonged use of PPIs for durations surpassing 6 months may potentially reduce bone mineral density among young adults. Nevertheless, this observed impact does not attain clinically significant levels of osteopenia. Conversely, using PPIs for periods under 6 months did not significantly affect bone mineral density.

Sigmoid volvulus (SV) is an uncommon cause of intestinal obstruction resulting from axial twisting of the sigmoid colon around its mesenteric base. In the absence of complications, endoscopic detorsion is considered the first-line treatment, whereas urgent surgery is required in cases of perforation, peritonitis, or failed detorsion (1). The “coffee bean sign” (massively dilated sigmoid loop directed to the right upper quadrant) and the “whirl sign” (twisting of mesentery and vessels) are well-established radiological findings of SV (2). By contrast, endoscopic features are less well characterized, and evaluating mucosal ischemia or necrosis endoscopically remains challenging. Completely black mucosa is indicative of full-thickness necrosis, while borderline ischemia may present with variably discolored mucosa, including yellowish and reddish spots. In 2021, Uysal et al. described this finding as the “fallen leaves in autumn” sign, reflecting superficial necrosis with preserved viability of deeper layers. We report the case of an 83-year-old male admitted to the emergency department with abdominal pain and rectal bleeding. Imaging revealed classic signs of SV (Figure 1). During endoscopic detorsion, findings consistent with borderline ischemia were noted: loss of submucosal vascularity and scattered reddish-yellowish dots, some confluent. Areas suspected of complete necrosis displayed black mucosa with a sandpaper-like appearance (Figure 2). The patient underwent surgery for irreversible ischemia (Figure 3) but unfortunately died a few days later due to postoperative complications. This case highlights that the “fallen leaves in autumn” sign may serve as a useful endoscopic descriptor of borderline ischemia in SV, complementing established radiological features.