Person: BİBERCİ KESKİN, ELMAS
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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 Open Access Can serum histone H4 levels predict mucosal healing in Crohn-s disease?(2021-01-01T00:00:00Z) KÖKER, İBRAHİM HAKKI; SÜMBÜL, BİLGE; KİREMİTÇİ, SERCAN; KOÇHAN, KORAY; İNCE, ALİ TÜZÜN; BİBERCİ KESKİN, Elmas; ŞENTÜRK, HAKAN; KÖKER, İBRAHİM HAKKI; SÜMBÜL, BİLGE; KİREMİTÇİ, SERCAN; KOÇHAN, KORAY; İNCE, ALİ TÜZÜN; BİBERCİ KESKİN, ELMAS; ŞENTÜRK, HAKANIntroduction: Mucosal healing (MH) has been a treatment target with the introduction of biological agents in Crohn's disease (CD). Histone H4 increases in chronic inflammation. Aim: Our goal was to investigate the role of serum histone H4 in predicting MH. Material and methods: The study included 44 patients who applied to the endoscopy unit for ileocolonoscopic evaluation with the diagnosis of ileocecal CD and 26 healthy controls. After ileocolonoscopic evaluation, we divided the patients into 2 groups: those with and those without MH, according to the presence of endoscopic ulcer or erosion findings. Blood samples were taken from these patients to analyse serum histone H4 before the endoscopic procedure. We first compared serum histone H4 levels between CD patients and the healthy control group and then between those with and those without MH among the CD patients. Finally, we compared CRP, ESR, and serum histone H4 levels in patients with CD according to the presence of MH and symptoms. Results: Serum histone H4 levels were significantly higher in ileocolonic CD patients compared to the healthy control group (p = 0.002). Also, serum histone H4 levels were significantly higher in CD patients with no MH (p = 0.028) or symptomatic patients (p = 0.033). We did not find a significant difference in C-reactive protein and erythrocyte sedimentation rate levels between CD patients in the presence of MH (p = 0.281 and p = 0.203, respectively) or symptoms (0.779 and 0.652, respectively). Conclusions: Serum histone H4 might be a useful biomarker for MH prediction in ileocolonoscopic CD patients. Validation is needed for large numbers of patients.Publication Open Access Chronotype and Sleep Quality in Patients with Inflammatory Bowel Disease(2020-01-01T00:00:00Z) Keskin, Elmas; Sahbaz, Cigdem Dilek; BİBERCİ KESKİN, ELMAS; ŞAHBAZ, ÇIĞDEM DILEKAim: Chronotype and sleep disturbance are both considered risk factors for chronic autoimmune diseases. However, there is lack of knowledge with respect to chronic inflammatory bowel disease and chronotype patterns. Therefore, we investigated the chronotype and sleep quality in patients with ulcerative colitis and Crohn-s disease.Publication Open Access Evaluation of liver biopsy findings and comparison with noninvasive fibrosis scores in patients with non-alcoholic steatohepatitis Non-alkolik steatohepatitli hastalarda karaciğer biyopsi bulgularının değerlendirilmesi ve noninvazif fibroz skorları ile karşılaştırılması(2019-01-01T00:00:00Z) BİBERCİ KESKİN, Elmas; ÇOBAN, GANİME; BİBERCİ KESKİN, ELMAS; ÇOBAN, GANİMEObjective: Nowadays, the incidence of non-alcoholic fatty liver and steatohepatitis (NASH) is increasing and early diagnosis is of great importance. In this study, we investigated the place of Fibrosis-4 (FIB-4), Aspartate Aminotransferase to Platelet Ratio (APRI) and AST/ALT Ratio in predicting liver fibrosis and its most optimal cut-off value in NASH patients undergoing liver biopsy. Method: Patients with NASH who underwent liver biopsy were included in the study. Biopsy results of all patients were evaluated histopathologically and grade of fibrosis was graded. In addition, FIB-4, APRI and AST/ALT scores were calculated and compared with biopsy findings in these patients. Results: A total of 88 patients were included in the study. Of these patients 51 (58%) were female and the mean age of the study population was 52.7±9.5. According to biopsy results, NASH was detected in 79 (89.8%) and NAFLD in 9 (10.2%) patients. The cut-off values of <0.47 for APRI and <0.88 for FIB-4 scores showed the best discriminatory power in exclusion of liver fibrosis. Likewise, the cut-off value greater than 0.68 for APRI score and >2.16 for FIB-4 score showed the highest predictive value in predicting advanced fibrosis. AST/ALT ratio had not any diagnostic value. Conclusion: FIB-4 and APRI scores play an important role in the noninvasive prediction of fibrosis in NASH patients, but the AST/ALT ratio is not sufficient. On the other hand, although the guidelines recommend using these scoring systems as a screening tool, there is no clarity as to the appropriate ideal cut-off values. At this point, FIB-4 score stands out with high sensitivity and specificity especially in the prediction of severe fibrosis.Publication Open Access Mucin expression in mucinous pancreatic cysts: Can string sign test predict mucin types? A single center pilot study(2020-12-01T00:00:00Z) Köker, İbrahim Hakkı; Ünver, Nurcan; Malya, Fatma Ümit; Uysal, Ömer; Şentürk, Hakan; KÖKER, İBRAHİM HAKKI; MALYA, FATMA ÜMİT; BİBERCİ KESKİN, ELMAS; ŞENTÜRK, HAKANBackground: Mucinous pancreatic cystic lesions (PCLs) express different mucin (MUC) types according to their histomorphologic types. High cystic fluid viscosity may help in the detection of mucinous PCLs. We hypothesized that high cystic fluid viscosity may be suggestive of a certain MUC type in mucinous PCLs. Methods: Prespecified MUC types (MUC1, MUC2, MUC4, MUC5AC, and MUC6) were evaluated in 18 definitively diagnosed mucinous PCLs with sufficient tissue material and prediagnostic cyst fluid viscosity evaluation—string sign (SS)—test. We evaluated the agreement of MUC expression with positive SS test results. Later, we compared cystic fluid carcinoembryonic antigen (CEA) between the prespecified MUC expressing and nonexpressing cyst types. Results: A total of 18 mucinous PCL patients, 11 females, with mean age ± SD (59.7 ± 13.3) were included. Almost all malignant mucinous PCLs expressed MUC1 (71.4%) (P = .023). We found no significant agreement between the prespecified MUC types and positive SS, except MUC4 which had mild agreement. Also, no significant relation was found between cystic fluid CEA levels and MUC expression (P = .584). Conclusion: We did not detect a significantly moderate or good agreement between the prespecified MUC types and SS test. MUC1 was highly expressed in malignant mucinous cysts; however, it was incompatible with the SS test. MUC4 expression showed mild agreement with the SS test in a small number of patientsPublication 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 Open Access Cyst Fluid Carcinoembryonic Antigen Level Difference between Mucinous Cystic Neoplasms and Intraductal Papillary Mucinous Neoplasms(2020-12-01T00:00:00Z) KÖKER, İBRAHİM HAKKI; Ünver, Nurcan; MALYA, FATMA ÜMİT; UYSAL, ÖMER; BİBERCİ KESKİN, ELMAS; ŞENTÜRK, HAKAN; KÖKER, İBRAHİM HAKKI; MALYA, FATMA ÜMİT; UYSAL, ÖMER; BİBERCİ KESKİN, ELMAS; ŞENTÜRK, HAKAN