Background: Incontinence is not rare after rectal cancer surgery. Platelet-rich plasma may promote tissue repair and generation but has never been tested for the treatment of anal incontinence. This study evaluated the impact of platelet-rich plasma injection on the severity of incontinence and quality of life after low rectal cancer surgery. Methods: This is a prospective cohort proof of concept study in a colorectal cancer institution. Patients had undergone low anterior or intersphincteric resection for low rectal cancer and had a Wexner score > 4. Ten milliliters of platelet-rich plasma were injected into the internal and external sphincters under endoanal ultrasound (EAUS) guidance. Primary outcome measure was > 2 point improvement in Wexner score (improved group). The patients were assessed with endo-anal ultrasound examination, manometry, the Wexner Questionnaire and SF-36 Health Surveys, and patients were asked whether they used pads and antidiarrheal medications before and 6 months after PRP injection. Results: Of 20 patients included in the study, 14 (70%) were men, and the average age was 56.8 (SD = 9.5) years. No statistically significant difference was found in Wexner scores before and after PRP injection (p = 0.66). Seven (35%) patients experienced a > 2 point improvement in Wexner score. Rectal manometry demonstrated improved squeezing pressure (p = 0.0096). Furthermore, physical functioning scoring (p = 0.023), role limitation (p = 0.016), emotional well-being (p = 0.0057) and social functioning (p = 0.043) domains on the SF-36 questionnaire improved. One (5%) and three (15%) patients stopped using pads and antidiarrheal medications. Conclusion: Platelet-rich plasma injection does not restore Wexner scores, but more than one-third of patients may benefit from this application with an improvement of > 2 points in their scores. Platelet-rich plasma injection may improve squeezing pressure and certain life quality measures for incontinent patients after rectal cancer surgery.

Objective: Inflammatory bowel diseases (IBDs) are polygenic disorders. Patients with IBD, especially ulcerative colitis (UC), are more vulnerable to infections because of medications. Key COVID-19-related factors/risks have not been well-researched in IBD patients. In this study, we compared IBD patients with control patients who presented to our clinic with COVID-19 infection suspicion regarding COVID-19 PCR test positivity, COVID-19 pneumonia, hospitalization, and need for treatment at the intensive care unit (ICU). Material and Methods: Thiscohort study included 480 IBD patients as cases and 9,269 age- and gender-matched control patients who came to our hospital for complaints/checkups and were tested for COVID-19 PCR. Results: Covid-19 positivity was higher in IBD patients than in controls. COVID-19 pneumonia rates were higher in IBD compared to the pneumonia rate of Turkey — mainly due to the high prevalence of COVID-19 pneumonia in UC as none of the Crohn’s disease (CD) patients experienced COVID-19 pneumonia. Hospitalization was significantly higher in UC than in CD and higher in IBD than in controls. Hospitalization at ICU was significantly higher in UC than in the controls. There were no IBD patients who died because of COVID-19 infection. Conclusion: IBD patients have a significantly higher rate of COVID-19 PCR positivity, COVID-19 pneumonia, hospitalization, and the need for ICU than the controls; however, mortality is comparable.

Objectives: The relationship between heavy metal and trace element levels in IBD and the clinical course is unclear. The research team evaluated serum levels of heavy metals and trace elements in patients with IBD compared with healthy participants to establish their connection with IBD severity and inflammatory markers. Methodology: This single-center, retrospective cross-sectional study was conducted at the Department of Gastroenterology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey, with stored samples analyzed from 17 October to 17 November 2024. The study included 137 patients with IBD (90 with ulcerative colitis, 47 with Crohn’s disease) and 60 healthy controls. Patients were grouped according to disease severity as mild, moderate, and severe. Serum levels of heavy metals (nickel, aluminum) and trace elements (iron, zinc, selenium, ferritin, vitamin D) were measured. Correlations with C-reactive protein (CRP), sedimentation rate, and fecal calprotectin were examined. Results: Nickel levels were higher in the IBD group than in controls (1.19±1.04 vs 0.51±0.39 µg/L; median 1.2 [IQR 0.5-1.6] vs 0.4 [0.2-0.7] µg/L; p<0.001). Iron deficiency was present in 54% of patients compared with 16.7% of controls (p<0.001). Zinc and ferritin levels were significantly lower in the patient group (p<0.001). Aluminum strongly correlated with CRP (r=0.69, p<0.001). Multivariate analysis showed a 7.36-fold higher likelihood of IBD associated with elevated nickel levels (OR=7.36; 95% CI: 3.23–16.75; p<0.001). Conclusion: Nickel accumulation and iron deficiency were associated with IBD severity and may impact pathogenesis. No independent relationship was established for other heavy metals and micronutrients.