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Background and Objectives: Reliable laboratory markers that accurately reflect disease activity in ankylosing spondylitis (AS) are limited. Conventional acute-phase reactants do not consistently correlate with clinical activity. Composite hematological indices derived from complete blood count may better capture systemic inflammatory burden. In this study, we aimed to investigate hematologic parameters in AS and to assess their relationships with disease activity. Materials and Methods: This retrospective observational study included 196 patients with AS. Disease activity was defined as a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4. Demographic variables, laboratory parameters, hematological indices, and extra-articular manifestations were evaluated. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression with ten-fold cross-validation. Variables with non-zero coefficients were entered into a multivariable logistic regression model. Model performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: Ninety-seven (49%) patients had active disease. LASSO regression identified erythrocyte sedimentation rate (ESR), white blood cell count, red cell distribution width (RDW), platelet-to-lymphocyte ratio (PLR), and selected extra-articular manifestations as relevant predictors. In multivariable logistic regression, ESR (OR 1.03, 95% CI 1.00–1.06), white blood cell count (OR 1.23, 95% CI 1.04–1.46), and PLR (OR 1.01, 95% CI 1.003–1.020) were independently associated with active disease, while RDW showed a borderline association. The model demonstrated good discriminative ability (AUC 0.77, 95% CI 0.69–0.84). Conclusions: PLR is independently associated with disease activity in ankylosing spondylitis and improves discrimination when incorporated into a multivariable model. Easily accessible hematological indices may complement traditional inflammatory markers in the assessment of disease activity in routine clinical practice.

Objectives Helicobacter pylori is a major cause of gastritis and a potential trigger of inflammatory disease. The effect of H pylori infection on distal femoral cartilage has yet to be evaluated. The aim of this study was to evaluate femoral cartilage thickness in patients with H pylori infection and to find whether this infection affects femoral cartilage thickness. Methods This cross‐sectional study included 199 patients. To measure the thickness of femoral articular cartilage, 99 patients with H pylori infections and 100 with H pylori‐negative controls were enrolled into two groups. The measurements were made using linear probe ultrasonography with the patients in supine positions and their knees in maximum flexion. Demographic, clinical, endoscopic and laboratory data were collected for all patients. Results Both the right and left femoral condyles had thinner cartilage thickness in the H pylori‐positive group than in the H pylori‐negative group (P = .016, P = .036). For the intercondylar area and lateral femoral condyles, although the H pylori‐positive patients had thinner femoral cartilage thickness than the H pylori‐negative individuals for both extremities, this finding was not statistically significant (P > .05). Conclusion Femoral cartilage was thinner in patients with H pylori than patients without H pylori for right and left medial femoral condyles. This study suggests that H pylori infections may affect femoral cartilage thickness and potentially increase the risk of cartilage degeneration.

Objective Hyperthyroidism’s impact on cardiovascular, hematopoietic systems and metabolism might lead to hemorheological changes. This study aimed to investigate the changes in hemorheological properties via erythrocyte deformability and aggregation, whole blood viscosity (WBV) and plasma viscosity (PV) in hyperthyroid patients. The effect of anti-thyroid treatment on hemorheology was also studied. Material methods Thirty-six patients with overt hyperthyroidism, 19 patients with subclinical hyperthyroidism and 66 controls were included in the study. Hematocrit, erythrocyte deformability and aggregation, plasma and whole blood viscosity values were measured before treatment. Hemorheological parameters of the patients were compared with the control. Before and after treatment results of overt hyperthyroidism were analyzed. Methimazole was given as anti-thyroid treatment. Deformability and aggregation measurements were conducted using a laser ektacytometer (LORRCA) while viscosity measurements were performed with a cone-plate viscometer (Brookfield DV-III). Results The maximum elongation index (EImax) decreased significantly from 0.664 (0.01) pre-treatment to 0.657 (0.01) post-treatment ( p  = 0.04). The aggregation index was significantly higher in both the subclinical hyperthyroidism group [68.05 (7.66), p  = 0.001] and the overt hyperthyroidism group [66.78 (8.815), p  = 0.001] compared to the control group. Additionally, the aggregation half-time was significantly shorter in the subclinical hyperthyroidism group [1.9 (1.21–2.27), p  = 0.001] and the overt hyperthyroidism group [1.91 (1.43–2.46), p  = 0.001] relative to the control group. Conclusion The hemorheological status of patients was influenced by excessive thyroid hormones in both subclinical and overt hyperthyroidism groups. Additionally, anti-thyroid therapy with methimazole may play a role in the observed decrease in the maximum elongation index following treatment.

To the Editor： Cholinergic urticaria （CU） is a type of physical urticaria characterized by a number of short-lasting, highly pruritic weals. The underlying pathological mechanism of CU is not fully understood. Omalizumab is a humanized, monoclonal IgG anti-lgE antibody that binds specifically to circulating lgE molecules, thus interrupting the allergic cascade, The efficacy of anti-lgE treatment has been shown in many disorders with complex and unclear etiology, comprising physical urticarias, chronic idiopathic urticaria, angioedema and eosinophil-associated gastrointestinal disorders.

Predicting which patients will need the intensive care unit (ICU) due to severe COVID-19 is critical in terms of disease treatment. In this study, the use of the derived isohemagglutinin (dIH) parameter calculated from isohemagglutinin (IH) values and neutrophil to lymphocyte ratios for prediction of clinical care (CLC), ICU admission and mortality status was investigated for the morbidity and mortality of COVID-19. The data of approximately 21,500 patients admitted to the hospital with the suspicion of COVID-19 were scanned retrospectively. A total of 352 patients with IH results were divided into three groups according to CLC, ICU admission and mortality. Isohemagglutinin, hemogram and biochemistry test results, demographic characteristics, chronic diseases, length of stay, treatments, ICU admission and mortality records were reviewed for all patients. The relationship between test results, demographic characteristics, clinical status and mortality was investigated using statistical methods. The dIH values of patients with ICU admission and mortality were much lower than those of CLC patients [median (min-max): 3.34 (0.14-95.8) and 0.82 (0.05-42.3) vs. 0.18 (0.01-20.6) titers, p < 0.01, respectively]. In the ROC analysis for the power of dIH to discriminate ICU admission, the cutoff was ≤ 0.68 with sensitivity 88.9%, and specificity 79.6%. It was determined that a 1-unit increase in dIH values decreased the need for ICU by 2.09 times and the mortality of those receiving ICU treatment by 2.02 times. dIH values calculated in the early stages of the disease in patients with COVID-19 can be used to estimate the clinical progression associated with ICU admission and mortality.

Data are relatively scarce on gastro-intestinal tuberculosis (GITB). Most studies are old and from single centers, or did not include immunosuppressed patients. Thus, we aimed to determine the clinical, radiological, and laboratory profiles of GITB. We included adults with proven GITB treated between 2000 and 2018. Patients were enrolled from 21 referral centers in 8 countries (Belgium, Egypt, France, Italy, Kazakhstan, Saudi Arabia, UK, and Turkey). One hundred four patients were included. Terminal ileum (n = 46, 44.2%), small intestines except terminal ileum (n = 36, 34.6%), colon (n = 29, 27.8%), stomach (n = 6, 5.7%), and perianal (one patient) were the sites of GITB. One-third of all patients were immunosuppressed. Sixteen patients had diabetes, 8 had chronic renal failure, 5 were HIV positive, 4 had liver cirrhosis, and 3 had malignancies. Intestinal biopsy samples were cultured in 75 cases (78.1%) and TB was isolated in 65 patients (86.6%). PCR were performed to 37 (35.6%) biopsy samples and of these, 35 (94.6%) were positive. Ascites samples were cultured in 19 patients and M. tuberculosis was isolated in 11 (57.9%). Upper gastrointestinal endoscopy was performed to 40 patients (38.5%) and colonoscopy in 74 (71.1%). Surgical interventions were frequently the source of diagnostic samples (25 laparoscopy/20 laparotomy, n = 45, 43.3%). Patients were treated with standard and second-line anti-TB medications. Ultimately, 4 (3.8%) patients died and 2 (1.9%) cases relapsed. There was a high incidence of underlying immunosuppression in GITB patients. A high degree of clinical suspicion is necessary to initiate appropriate and timely diagnostic procedures; many patients are first diagnosed at surgery.

Introduction: To date, the world has experienced four waves of the Coronavirus disease- 19 (COVID-19) pandemic. Patients infected during the era of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant were the subject of this study. The objectives were to describe their clinical manifestations, explain their laboratory and radiological findings, conclude factors contributing to clinical outcomes, and evaluate treatment protocols. Methodology: Relevant data were collected retrospectively from records of patients admitted to six referral centers in four countries. Data included sociodemographic patterns, symptoms, associated comorbidities, physical examination, laboratory and radiologic findings, treatment received, and patient outcomes. Results: Data analysis identified symptomatology and variables related to acquisition and infection outcome. The most prevalent symptoms were cough (81.5%), body aches (74.1%), and fever (71.6%). Independent risk factors for mortality were age, vomiting, epigastric pain, diabetes, obesity, oxygen saturation less than 90%, leukocytosis, neutrophilia, lymphopenia, thrombocytopenia, elevated creatinine, high glucose level, lung ground glass opacities with consolidation, affection of four lobes and bilateralism. Neither d-dimer nor lactate dehydrogenase nor ferritin foretells death possibility. The efficacy of the medications used was convenient. Conclusions: Assessing the clinical features of different COVID-19 waves, identifying predictors of outcomes, and concluding the efficacy of treatment protocols provide insight into patients’ responses and viral behaviors, which help in the proper diagnosis and treatment of subsequent surges.

Background/Aim: Increasing resistance of Helicobacter pylori to antimicrobials necessitated the development of new regimens and the modification of existing regimens. The present study aimed to compare the efficacy of two bismuth-containing quadruple regimens-one including clarithromycin (C) instead of metronidazole (M) and triple therapy. Patients and Methods: Patients with H. pylori infection given the following regimens were sequentially enrolled in this retrospective study: (1) Triple therapy: Lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and amoxicillin 1 g b.i.d., (2) bismuth group C: Lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d., and bismuth subsalicylate 524 mg b.i.d., and (3) bismuth group M: Lansoprazole 30 mg b.i.d., amoxicillin 1 g b.i.d., metronidazole 500 mg t.i.d., and bismuth subsalicylate 524 mg b.i.d. for 14 days. Gastroscopy and 14 C-urea breath test were performed before enrollment, and urea breath test was repeated four weeks after the treatment. Results: At per-protocol analysis, the eradication rates were 64.7% (95% confidence interval 60.4-68.7) with the triple therapy (n = 504), 95.4% (95% confidence interval 91.5-99.4) with the bismuth group C (n = 501), and 93.9% (95% confidence interval 89.7-98.7) with the bismuth group M (n = 505). The eradication rates were similar between the two bismuth groups (P > 0.05) but significantly greater than that of the triple therapy (P < 0.05). Conclusion: In our study, both of the bismuth-containing quadruple therapies reached high eradication rates, whereas triple therapy was shown to be ineffective. Moreover, clarithromycin may also be a component of bismuth-containing quadruple therapy.

Video endoscopic diagnosis of gastric varices is particularly limited, owing to the deep submucosal or subserosal location of the varices and the normal appearance of the overlying mucosa. We present and emphasise the value of computerised tomography (CT) examination in the early detection of gastric varices (GVs). In this retrospective study, a total of 216 consecutive patients with cirrhosis were evaluated at the Turkiye Yuksek Ihtisas Training and Research Hospital between September 2008 and March 2011. One hundred and thirty patients with cirrhosis were enrolled in the study. The mean age of the male (88 cases) patients was 59.45 ±2.42 years, and the mean age of the female (42 cases) patients was 56.29 ±1.14 years. Computerised tomography identified oesophageal varices (EVs) in 103/130 patients, and endoscopy identified EVs in 103/130 patients. Computerised tomography identified GVs in 86/130 patients, and endoscopy identified GVs in 26/130 patients. After endoscopic elastic band ligation (EBL), CT identified GVs in 22/26 patients, and endoscopy identified GVs in 7/26 patients. Gastric varices lie in the submucosa, deeper than EVs, and distinguishing GVs from gastric rugae may be difficult with video endoscopy. This study demonstrated that CT is a sensitive method for early detection of GVs and has been used previously in the evaluation of GVs.

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is a clinical syndrome characterised by gross dilation of the caecum and right hemicolon, which sometimes extends to the sigmoid colon and rectum in the absence of an anatomic lesion in the intestinal lumen. It is characterised by impaired propulsion of contents of the gastrointestinal tract, which results in a clinical picture of intestinal obstruction. A careful examination of the markedly distended colon can exclude several colonic pathologies, including mechanical obstruction and other causes of toxic megacolon. ACPO can sometimes predispose or mimic colonic volvulus, especially in geriatric patients.