Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Elevated Levels of Fecal Calprotectin in Cirrhotic Patients and Spontaneous Bacterial Peritonitis

Amaç: Bu çalışmanın amacı, intestinal inflamasyonun göstergesi olan fekal calprotectin (FC) ile artmış intestinal inflamasyon ve buna bağlı artan bakteriyel translokasyon sonucu meydana gelen sirozun komplikasyonları arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: Hastanemize başvuran 18 ve 80 yaş arası 156 sirotik hastadan, dışlama kriterlerine göre 64’ü çıkartıldı ve toplam 92 hasta ve benzer yaş ve cinsiyette 20 gönüllü kontrol grubu olarak çalışmaya dahil edildi. Başvuru sırasında alınan kan örneklerinden eritrosit sedimantasyon değeri (ESR), c-reaktif protein (CRP) ve beyaz küre sayımı (WBC) çalışıldı. Her hastadan ve kontrol grubundan başvurudan sonraki 24 saat içinde bir adet spot gaita örneği alındı. Çalışma grubu, sirozun evresi ilerledikçe veya komplikasyonlar meydana geldiğinde FC değerlerinin değişip değişmediğini incelemek için beş alt gruba (Child-Pugh Evre-A, Evre-B, Evre-C, hepatiks ensefalopati ve spontan bakteriyel peritonit) ayrıldı.Bulgular: Ortanca FC değerleri sirotik hastalarda 168,8 mg/kg ve kontrol grubunda 9,8 mg/kg idi ve gruplar arasındaki farklılık istatistiksel olarak anlamlıydı (p=0,039). Alt grup incelemesinde, spontan bakteriyel peritonit grubu ile diğer tüm alt gruplar arasındaki farklılıklar istatistiksel olarak anlamlıydı (p=0,002). Sirotik hastalarda FC ile ESR (r=0.439, p=0.545) veya CRP (r=0.403, p=0.321) ya da WBC sayımı (r=0.061, p=0.645) arasında korelasyon saptanmadı.Sonuç: Sirotik hastalarda FC değerleri yükselmektedir ve sistemik inflamasyon belirteçlerinden önce FC değerlerinin erken yükselmesi sayesinde, spontan bakteriyel peritonitte tanısal bir test olarak kullanılabilir

Inflammatory cloacogenic polyp: a rare kind of benign polyp to be cured with endoscopic and/or surgical removal

Background: Inflammatory cloacogenic polyp is a very rare kind of benign polyp which occurs in the anal transitional zone and lower rectum. These polyps arise in association with various conditions (e.g., internal hemorrhoids, diverticulosis, colorectal tumors, and Crohn's disease) in which mucosal injury is the underlying pathogenic mechanism. Case report: A 24-year-old male patient applied to emergency department with bloody defecation for a month. A polyp that is 1.5 cm in size had been observed at rectum and anal verge junction during colonoscopy, pathological diagnosis was inflammatory cloacogenic polyp. Thereupon, colonoscopic polypectomy was performed as the malignant transformation possibility. Conclusion: Polyps of the anorectal junction with inflammatory appearance might be inflammatory cloacogenic polyps with malignant transformation potential that must be treated by endoscopic removal or surgery and followed up routinely with colonoscopic surveillance. Resumo: Experiência: Pólipos cloacogênicos inflamatórios constituem um tipo muito raro de pólipo benigno, com ocorrência na zona de transição anal e reto baixo. Esses pólipos surgem em associação com diversos distúrbios (p. ex., hemorroidas internas, diverticulose, tumores colorretais, e doença de Crohn) nos quais a lesão à mucosa é o mecanismo patogênico subjacente. Relato de caso: Paciente, gênero masculino, 24 anos, compareceu ao serviço de emergência com defecação sanguinolenta com duração de um mês. Durante a colonoscopia, foi observado um pólipo medindo 1,5 cm de diâmetro no reto e na junção da borda anal; foi estabelecido um diagnóstico patológico de pólipo cloacogênico inflamatório. Subsequentemente, foi realizada polipectomia colonoscópica, diante do potencial de transformação maligna. Conclusão: Pólipos da junção anorretal com aspecto inflamatório podem ser pólipos cloacogênicos inflamatórios com potencial para transformação maligna, devendo ser tratados por remoção endoscópica ou cirúrgica e monitorados periodicamente com vigilância colonoscópica. Keywords: Inflammation, Solitary rectal ulcer, Cloacogenic polyp, Palavras-chave: Inflamação, Úlcera retal solitária, Pólipo cloacogênic

Hepatitis B Virus Belated Reverse Sero-conversion After Hematopoietic Stem Cell Transplantation or Rituximab Chemotherapy

Recovery and immunity to hepatitis B virus (HBV) are marked by antibody to hepatitis B core antigen (anti-HBc) with or without antibody to hepatitis B surface antigen (anti-HBs) in the absence of hepatitis B surface antigen (HBsAg). In the profoundly immune compromised individual, HBV may reactivate even in the presence of serologic evidence of resolved infection. The loss of anti-HBs followed by reactivation with development of HBsAg is known as reverse sero-conversion. A 62-year-old female patient with the diagnosis of IgG type of multiple myeloma had received bortezomib-based chemotherapy, and autologous hematopoietic stem cell transplantation (HSCT) was performed thereafter. A 56-year-old male patient with the diagnosis of chronic lymphocytic leukemia had received 6 cures of rituximab-endoxan chemotherapy. Prior to chemotherapy, HBsAg was negative, anti-HBs positive, anti- HBc positive and HBV-DNA was negative in both patients. Approximately one year after chemotherapy, HBV reverse sero-conversion developed in both patients. Resolved HBV infection with undetectable HBV-DNA before chemotherapy or HSCT did not confer HBV reverse sero-conversion. Prior to the creation of regular follow-up or prophylaxis schemes of patients with resolved HBV infection, in whom immune suppressive and anti-cancer treatments or HSCT will be performed, close follow-up of patients for HBV reverse sero-conversion even in late stages after immune suppressive and anti-cancer treatments or HSCT seems beneficial, especially in regions with intermediate or high endemicity for HBV

Routinely evaluated clinical assays and laboratory tests [real test] and fibrosis stages of chronic hepatitis B and C

Background/Aims: To provide a new mathematical formula to predict liver fibrosis in patients with chronic viral hepatitis. Materials and Methods: Patients with chronic hepatitis B and C who underwent liver biopsy at different centers were included in this study. Chronic hepatitis B was defined as immunopositivity for the hepatitis B surface antigen for at least 6 months, and chronic hepatitis C was defined as positivity for HCV RNA for at least 3 months. The histological features were evaluated by the histological activity index and fibrosis. Results: In total, 1299 patients were included in the study. The distribution and the mean of the parameters of the patients were as follows: 1009 patients with chronic hepatitis B with a mean age of 45±13/years [emale/male (F/M)47.5/52.5%] and 290 patients with hepatitis C with a mean age of 52±cut-off value of the REAL TEST formula&quot;[(age x pT x AST)/(PLT/1000)]/100&quot; in patients with hepatitis B was determined to be <1.37, it was found that it could predict fibrosis with 79% specificity, 78% sensitivity, 85% negative predictive value (NPV), and 70% positive predictive value (PPV) (area under the curve (AUC)0.852, 95% CI:0.820.87). When the cut-off value of the REAL TEST formula in patients with hepatitis C was determined to be <1.99, it was found that it could predict significant fibrosis with 87% specificity, 90% sensitivity, 94.4% NPV, and 79.4% PPV (AUC:0.95, 95% CI:0.93-0.98)Conclusion: The REAL TEST formula results correlated with the pathological findings and may be a useful method for the evaluation of patients with chronic hepatitis B and C

Macroscopic Portal Vein Thrombosis in Hcc Patients

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD 10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development.PubMedWoSScopu