Person: BİBERCİ KESKİN, ELMAS
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Publication Metadata only EFFECT OF CHOLECYSTECTOMY ON PREVENTING RECURRENCE OF ACUTE PANCREATITIS(2022-10-11) Seven G.; Musayeva G.; İnce A. T.; Biberci Keskin E.; SEVEN, GÜLSEREN; İNCE, ALİ TÜZÜN; BİBERCİ KESKİN, ELMASBackground and AimsCurrent guidelines recommend cholecystectomy in patients with acute biliary pancreatitis (ABP) to prevent recurrence. Some studies suggest that a significant portion of patients with idiopathic acute pancreatitis (IAP) results from occult biliary disease and cholecystectomy, after an episode of IAP, reduces the risk of recurrent pancreatitis. However, in these studies, the work-up for potential biliary cause is not extensive and do not include endoscopic ultrasound (EUS), which can detect a biliary disease up to one-third of patients with IAP. In this study, we aimed to ascertain whether cholecystectomy can prevent pancreatitis recurrence in patients with ABP and IAP.MethodsAdult patients (over 18 years) with first episode of acute pancreatitis (AP) who admitted to inpatient clinic between January 1, 2015 and December 31, 2021 at a tertiary referral center were retrospectively reviewed. Medical records were scrutinized and relevant data extracted. In addition, a questionnaire either by mail or telephone was used. Patients with biliary and idiopathic AP were included in the analysis. Patients with chronic pancreatitis, previous pancreatic surgery, pancreatic cancer, and other etiologies were excluded. Primary outcome was recurrence rate. The diagnosis of IAP was confirmed by exclusion of all known etiological factors for AP using extensive work-up, including EUS and/or magnetic resonance cholangiopancreatography (MRCP).ResultsA total of 500 patients with first episode of AP (300 patients with ABP and 200 patients with IAP) were identified. The mean age was 58 years and 267 women, 233 men. The patients were divided into three different groups: Group 1; patients who had their first pancreatitis attack after cholecystectomy, Group 2; patients who had their gallbladder in situ during the first attack and followed by cholecystectomy and Group 3; patients who had their gallbladder in situ during the first attack but did not have cholecystectomy. The number of patients with recurrence after the first episode of AP were not statistically different in whole study group (25%, 19% and 15%, respectively, P = 0.176). In the subgroup of patients with ABP, the recurrence was higher in group 1 as compared with group 2 and 3 (39%, 19% and 14%, respectively, P = 0.018). On the other hand, in the subgroup of patients with IAP, there was no significant difference among the groups in terms of recurrence (15%, 18%, and 17%, respectively, P = 0.999). When patients with in situ gallbladder during their first attack were compared according to their cholecystectomy history (group 2 vs. group 3), no significant difference was found in neither the ABP nor the IAP subgroups (19% vs 14% and 18% vs. 17%, respectively, P > 0.05). In addition, the effect of endoscopic retrograde cholangiopancreatography (ERCP) on recurrence of pancreatitis was evaluated. In subgroup of ABP, ERCP was effective for reducing the recurrence in group 2 (P = 0.008), while it was not found statistically significant in group 1 and 3. In subgroup of IAP, it ERCP did not reduce the recurrence in any of the groups.ConclusionsIn ABP, the recurrence is high in patients who have their first pancreatitis attack after cholecystectomy. Cholecystectomy alone is not effective preventing recurrence in patients with gallbladder in situ during the first episode; however, the risk can be decreased with adding ERCP to cholecystectomy. On the other hand, cholecystectomy is not effective in reducing the recurrence in patients with IAP.Key Words: Acute biliary pancreatitis; Idiopathic acute pancreatitis; Cholecystectomy.References:1. Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. American Gastroenterological Association Institute Clinical Guidelines Committee. Gastroenterology. 2018 Mar;154(4):1096-1101.2. Räty S, Pulkkinen J, Nordback I, et al. Can Laparoscopic Cholecystectomy Prevent Recurrent Idiopathic Acute Pancreatitis?: A Prospective Randomized Multicenter Trial. Ann Surg. 2015 Nov;262(5):736-41.3. D S Umans, N D Hallensleben , R C Verdonk, et al. Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis. Br J Surg 2020 Feb;107(3):191-199.Publication Open Access Cyst Fluid Carcinoembryonic Antigen Level Difference between Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms.(2020-12-11T00:00:00Z) Köker, İbrahim Hakkı; Ünver, Nurcan; Malya, Fatma Ümit; Uysal, Ömer; Keskin, Elmas Biberci; Şentürk, Hakan; MALYA, FATMA ÜMİT; UYSAL, ÖMER; BİBERCİ KESKİN, ELMAS; ŞENTÜRK, HAKANBackground/aims: The role of cyst fluid carcinoembryonic antigen (CEA) level in differentiating mucinous pancreatic cystic lesions (PCLs) is controversial. We investigated the role of cyst fluid CEA in differentiating low-risk (LR)-intraductal papillary mucinous neoplasms (IPMNs) from high-risk (HR)-IPMNs and LR-mucinous cystic neoplasms (MCNs). Methods: This was a retrospective study of 466 patients with PCLs who underwent endoscopic ultrasound-guided fine-needleaspiration over a 7-year period. On histology, low-grade dysplasia and intermediate-grade dysplasia were considered LR, whereas high-grade dysplasia and invasive carcinoma were considered HR. Results: Data on cyst fluid CEA levels were available for 50/102 mucinous PCLs with definitive diagnoses. The median CEA (range) levels were significantly higher in HR cysts than in LR cysts (2,624 [0.5-266,510] ng/mL vs. 100 [16.8-53,445]ng/mL, p=0.0012). The area under the receiver operating characteristic curve (AUROC) was 0.930 (95% confidence interval [CI], 0.5-0.8; p<0.001) for differentiating LR-IPMNs from LR-MCNs. The AUROC was 0.921 (95% CI, 0.823-1.000; p<0.001) for differentiating LR-IPMNs from HR-IPMNs. Both had a CEA cutoff level of >100ng/mL, with a negative predictive value (NPV) of 100%. Conclusion: Cyst fluid CEA levels significantly vary between LR-IPMNs, LR-MCNs, and HR-IPMNs. A CEA cutoff level of >100ng/mL had a 100% NPV in differentiating LR-IPMNs from LR-MCNs and HR-IPMNs.Publication Open Access Comparison of Glasgow Blatchford and New Risk Scores to Predict Outcomes in Patients with Acute Upper GI Bleeding(2023-01-01) TAŞLIDERE B.; BİBERCİ KESKİN E.; ÖZDEMİR S.; Atsız A.; SÖNMEZ E.; TAŞLIDERE, BAHADIR; BİBERCİ KESKİN, ELMAS; SÖNMEZ, ERTANObjective: Upper gastrointestinal (GI) bleeding constitutes a significant number of admissions to the emergency department, and it has high rates of morbidity and mortality. In this study, the contribution of new scores, such as The International Bleeding Risk Score (ABC score) and the Horibe GI bleeding prediction score (HARBINGER), to clinical practice was investigated. Using scores that are easy to calculate and memorable when used in the emergency department enables a more efficient use of medical resources. In addition, it may contribute to solving the problems regarding determining the need for intensive care in patients with upper GI bleeding. Methods: This study was conducted retrospectively on patients over the age of 18 who were admitted to the emergency department between September 1, 2018 and August 31, 2019. The HARBINGER and ABC scores and the Glasgow Blatchford score (GBS) were calculated for each patient. Following that, the need for intensive care, mortality, re-bleeding rate, and transfusion need were compared. Results: This study included 184 patients. When predicting the need for intensive care, the ABC score had a higher AUC value than the GBS and HARBINGER score, even when there was a low cut-off value (cut-off value >4). (AUC =0.944, specificity =0.74, sensitivity =0.83). Conclusion: This study found that the ABC score could be used to predict the need for intensive care in upper GI bleeding, and that it outperformed other scores. Additionally, we concluded that the HARBINGER score, which had a “shock index” among its parameters, was not effective in predicting in-hospital adverse eventsPublication Metadata only Comparison of the quick SOFA score with Glasgow-Blatchford and Rockall scores in predicting severity in patients with upper gastrointestinal bleeding(2021-02-01T00:00:00Z) Taşlıdere, Bahadır; Sönmez, Ertan; Özcan, Ayşe Büşra; Mehmetaj, Lıljana; Biberci Keskin, Elmas; Gulen, Bedia; TAŞLIDERE, BAHADIR; SÖNMEZ, ERTAN; ÖZCAN, AYŞE BÜŞRA; MEHMETAJ, LILJANA; BİBERCİ KESKİN, ELMASIntroduction: Upper gastrointestinal bleeding is one of the common causes of mortality and morbidity. The Rockall score (RS) and Glasgow-Blatchford score (GBS) are frequently used in determining the prognosis and predicting in-hospital adverse events, such as mortality, re-bleeding, hospital stay, and blood transfusion requirements. The quick Sepsis Related Organ Failure Assessment (qSOFA) score is easy and swift to calculate. The commonly used scores and the qSOFA score were compared and why and when these scores are most useful was investigated. Method: 133 patients admitted to the emergency department with upper gastrointestinal bleeding over the period of a year, were evaluated in this retrospective study. The RS, GBS and qSOFA score were calculated for each patient, and their relationship with in-hospital adverse events, such as length of hospitalization, rebleeding, endoscopic treatment, blood transfusion requirements, and mortality, was investigated. Results: The mean overall GBS was 9.72 ± 3.72 (0-19), while that of patients who did not survive was 14.0 ± 1.1 (13-16), with an area under the curve (AUC) of 0.901, a cutoff value of 12.5, and specificity (Spe) and sensitivity (Sen) of 1 and 0.82, respectively. The median value of the GBS, in terms of transfusion need, was 7.12 ± 4.01 (0-15). (AUC = 0.752, cut-off = 9.5, Spe = 0.79, Sen = 0.69). The median value of the qSOFA score, in terms of intensive care need, was 1.73 ± 0.7 (0-3) (AUC = 0.921, cut-off = 0.5, Spe = 0.93, Sen = 0.79). The RS median, in terms of re-bleeding, was 8.22 ± 0.97 (6-9). Conclusion: Early use of risk stratification scores in upper gastrointestinal bleeding is important due to the high risk of morbidity and mortality. All scoring systems were effective in predicting mortality, the need for intensive care, and re-bleeding. The GBS had a greater predictive power in terms of mortality and transfusion need, the qSOFA score for intensive care need, and the RS for re-bleeding. The simpler, more efficient, and more easily calculated qSOFA score can be used to estimate the severity of patients with upper gastrointestinal bleeding.Publication Open Access The relationship of Serum Histone H3.3 and H4 with chronic Hepatitis B(2020-09-01T00:00:00Z) Sümbül, Bilge; Şentürk, Hakan; Köker, İbrahim Hakkı; Koçhan, Koray; İnce, Ali Tüzün; Biberci Keskin, Elmas; İNCE, ALİ TÜZÜN; BİBERCİ KESKİN, ELMAS; SÜMBÜL, BİLGE; KOÇHAN, KORAY; KÖKER, İBRAHİM HAKKI; ŞENTÜRK, HAKANObjective: To determine the role of serum histone H3.3 and H4 in patients with chronic hepatitis B to explore any relationship between the two.Methods: The prospective controlled clinical pilot study was conducted in the Gastroenterology Clinic of Bezmialem Vakif University, Istanbul, Turkey, from January to October 2017, and comprised biopsy-proven patients with chronic hepatitis B and healthy controls. Demographics, hepatitis B virus deoxyribonucleic acid quantity, hepatitis B e-antigen, aspartate aminotransferase, alanine transaminase, international normalized ratio, total/direct bilirubin, albumin and thrombocyte counts as well as histological activity index and fibrosis scores were noted. Data was analysed using SPSS 22.Results: Of the 140 subjects, 70(50%) each were cases and controls. The overall mean age of the sample was 43.38±15.07 years (range: 18-70 years). There was positive correlation of histone H3.3 with hepatitis B virus deoxyribonucleic acid, aspartate aminotransferase, alanine transaminase and international normalized ratio levels. Histone H4 levels only correlated with hepatitis B virus deoxyribonucleic acid and international normalized ratio. Hepatitis B e-antigen positivity was present in 14(20%) of the cases.Conclusion: Histone H3.3 levels appeared to be associated with pathophysiological changes in chronic hepatitis B patients, suggesting that future treatments should target H3.3.Keywords: Histone H3.3, Histone H4, Extracellular histone, Chronic Hepatitis B, HBV.(JPMA 70: 1596; 2020)DOI:https://doi.org/10.5455/JPMA.19365Publication Metadata only Ampulla Vateri Tümörlerinde Endoskopik Rezeksiyon: Tek Merkezden 62 Hastanın Uzun Dönem Sonuçları(2022-11-22) Koçhan K.; Biberci Keskin E.; Şentürk H.; KOÇHAN, KORAY; BİBERCİ KESKİN, ELMAS; ŞENTÜRK, HAKANPublication Metadata only Bezmialem Vakıf Üniversitesi Tıp Fakültesi 4. 5. ve 6. Sınıf Öğrencilerin Kardiyopulmoner Resüsitasyon Bilgilerinin Yeterlilik Araştırması(2020-04-01T00:00:00Z) Gündoğan, Selman; Taşlıdere, Bahadır; Biberci Keskin, Elmas; TAŞLIDERE, BAHADIR; BİBERCİ KESKİN, ELMASAmaç: Herhangi bir nedenden dolayı kişide solunum ve dolaşımın durmasına -Kardiyopulmoner arrest- denir. Erken uygulanan kardiyopulmoner resüsitasyon hayat kurtarıcıdır. Amacımız Bezmialem Vakıf Üniversitesi’nde eğitim alan stajyer ve intörn doktorların kardiyopulmoner resüsitasyon bilgi düzeyleri ile bunu etkileyen faktörleri araştırmak ve elde edilen sonuçlara göre resüsitasyon başarısını arttırmaya yönelik önerilerde bulunmaktır. Araçlar ve Yöntem: Üniversitemiz 2018 - 2019 eğitim yılında 4, 5 ve 6. sınıf tıp fakültesi öğrencilerinden uygun olan 161 kişi çalışmaya dâhil edildi. 21.05.2019 – 11/219 numaralı etik kurul onayı alındı. Çalışma demografik bilgileri içeren anket formu ve güncel kılavuz temel alınarak hazırlanmış 34 sorudan oluşmaktaydı. Bulgular: Katılımcılardan 4 ve 5. sınıf öğrencilerin yaş ortalaması 23,54±7,158 iken 6. sınıf öğrencilerin yaş ortalaması 24±1,065, cinsiyet dağılımı açısından %64’ü kadın , %36’sı erkekti. Katılanların; %45,9’u beşinci, %30,8’i dördüncü ve %23,3‘ü altıncı sınıf öğrencisiydi. İntörn doktorlar ortalama 20,15, stajyer doktorlar ise 18,83 soruyu doğru yanıtladı. Sonuç: Kardiyopulmoner resüsitasyon tıp öğrencilerine verilmesi gereken önemli eğitimlerden biridir. İntörn doktorların doğru cevaplama oranı % 80,6, stajyer doktorların doğru cevaplama oranı %75,52 bulunmuştur ve bu oranlar arasındaki fark istatistiksel olarak anlamlıdır. Çalışmamızda intörn doktorlar ile stajyer doktorlar arasında bilgi düzeyi farklılığının anlamlı çıkması son sınıfta alınan acil tıp stajının ne kadar verimli geçtiğinin kanıtıdır. Araştırmada en düşük yanıt yüzdesi defibratör uygulaması ile ilgili olanlardı. Önceden resüsitasyon pratiği bulunan kişilerin sorulara verdikleri doğru yanıtlar anlamlıdır.Bu durum pratik sayısı artıkça bilgilerin daha kalıcı olduğunu göstermektedir. Tıp fakültelerinde teorik bilgilerin yanı sıra pratik eğitimlerinde yeterli derecede önemli hale getirilmesi mesleksel beceri kazanılması açısından önemlidir. Anahtar kelimeler: Kardiyopulmoner resüsitasyon, anket, tıp öğrencileri