Gallstone disease does not predict liver histology in nonalcoholic fatty liver disease

Background/Aims: We sought to examine whether the presence of gallstone disease (GD) in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) is associated with liver fibrosis and histological nonalcoholic steatohepatitis (NASH) score. Methods: We included 441 Turkish patients with biopsy-proven NAFLD. GD was diagnosed in the presence of sonographic evidence of gallstones, echogenic material within the gallbladder with constant shadowing and little or no visualization of the gallbladder or absence of gallbladder at ultrasonography, coupled with a history of cholecystectomy. Results: Fifty-four patients (12.2%) had GD (GD+ subjects). Compared with the GD- subjects, GD+ patients were older, had a higher body mass index and were more likely to be female and have metabolic syndrome. However, GD+ patients did not have a higher risk of advanced fibrosis or definite NASH on histology. After adjustment for potential confounding variables, the prevalence of GD in NAFLD patients was not associated with significant fibrosis (>= 2) (odds ratio [OR], 1.06; 95% confidence interval [Cl], 0.53 to 2.21; p=0.68) or definite NASH (OR, 1.03; 95% Cl, 0.495 to 2.12; p=0.84). Conclusions: The presence of GD is not independently associated with advanced fibrosis and definite NASH in adult Turkish patients with biopsy-proven NAFLD

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

İnsuline bağımlı olmayan diyabetik kombine hiperlipidemi olgularında atorvastatin tedavisi

Lipoprotein abnormalities associated with diabetes substantially contribute to the increased risk of macrovascular disease. the aim of this study was to investigate the efficacy and safety of atorvastatin in both diabetic and non-diabetic patients with combined hyperlipidemia who had no coronary artery disease. MATERIAL AND METHODS: Thirty eight patients with combined hyperlipidemia refractory to diet regulation of at least 3 months were enrolled in the study. Sixteen of them had diabetes mellitus type II. All patients received atorvastatin (10 mg/day) for 12 weeks. No other drugs that can affect the lipid metabolism were used during the study. Body mass index, serum lipid profiles, fibrinogen, whole blood counts, urine and blood chemistry analyses were followed. At the end of 12 weeks, efficacy and side effects were evaluated. Diabetic (on oral antidiabetic therapy) and non-diabetic patients were compared according to their response to atorvastatin. RESULTS: There were significant reductions in the serum levels of total-cholesterol, triglyserides (TG), LDL, and apolipoprotein (Apo) B in all patients. the levels of HDL cholesterol were significantly elevated. Total cholesterol levels reduced 31% in diabetics and 29% in non-diabetics. the reduction in TG levels were 36% and 21% respectively. Elevation of HDL (11%) in diabetics was comparable to the elevation of HDL (4%) in non-diabetics. LDL levels reduced 38% in diabetics and 44% in non-diabetics. the fibrinogen levels did not change significantly. There were no significant adverse events during the study. CONCLUSION: Atorvastatin is an efficient and safe antihyperlipidemic agent in the treatment of both diabetic and non-diabetic patients with combined hyperlipidemia. it 's benefit on TG, HDL and Apo B is greater in diabetic patientsAMAÇ: Diyabette meydana gelen lipoprotein bozuklukları, artmış makrovasküler hastalık riskinin önemli nedenlerinden biridir. Bu çalışmada, koroner arter hastalığı olmayan diyabetik ve non-diyabetik kombine hiperlipidemi olgularında atorvastatin tedavisinin etkinliği ve güvenilirliğinin araştırılması amaçlanmıştır. GEREÇ VE YÖNTEM: Çalışmaya en az 3 aylık diyet tedavisine dirençli 38 kombine hiperlipidemi olgusu alındı. Bunlardan 1 6 'sı insulin bağımlı olmayan tip-II diyabetikti. Tüm hastalara 12 hafta süre ile atorvastatin 10 mg/gün uygulandı. Çalışma süresince lipid metabolizmasını etkileyebilecek diğer ilaçlar kullanılmadı. Vücut kitle indeksi, serum lipid profilleri, fıbrinojen, tam kan sayımı, idrar ve kan biyokimyasal analizleri izlendi. on iki hafta sonunda hastalar diyabetik olup olmamalarına göre ilacın etkinliği ve güvenilirliği açısından karşılaştırmalı olarak değerlendirildiler. BULGULAR: Tüm hastalarda serum total-kolesterol, trigliserid (TG), LDL kolesterol ve apolipoprotein(Apo) B düzeylerinde anlamlı azalma elde edildi. HDL kolesterol düzeyleri ise arttı. Total kolesterol diyabetiklerde %31, diyabetik olmayanlarda %29 azaldı. TG düzeylerinde ise diyabetiklerde %36 ve diyabetik olmayanlarda %21 düşme vardı. HDL artışı ise diyabetiklerde %11 ve diyabetik olmayanlarda %4 düzeyinde idi. Yine diyabetiklerde LDL %38 non diyabetiklerde %44 azalmıştı. Fıbrinojen düzeylerinde ise anlamlı bir değişme olmadı. Çalışma süresince yan etki ile karşılaşılmadı. SONUÇ: Atorvastatin, hem diyabetik hem de diyabetik olmayan kombine hiperlipidemi olgularında etkin ve güvenilir bir antilipidemik ajandır. TG, HDL ve Apo B düzeylerine olan etkisi diyabetiklerde biraz daha güçlü görünmektedir

Sonographic Measurements of Rectus Femoris Muscle Thickness Strongly Predict Neutropenia in Cancer Patients Receiving Chemotherapy

The objective of this study was to explore the possible association between low skeletal muscle mass (SMM)—assessed by computed tomography (CT) and ultrasound (US)—and hematologic toxicity in cancer patients. A prospective cohort study was conducted in cancer patients who received anthracycline-based chemotherapy between 2018 and 2020 and who had baseline abdominal CT including L3 level for measuring SMM. Regional muscle measurements were carried out using US. A total of 65 patients (14 males, 51 females) were included. ROC (receiver operating characteristic) analysis identified threshold values of 18.0 mm [AUC (area under the curve) = 0.765] for females and 20.0 mm (AUC = 0.813) for males, predicting severe neutropenia. Using these cut-offs, females with low rectus femoris (RF) thickness (p = 0.005), and males with low RF values (p = 0.063). A regression analysis, irrespective of age, gender, and body mass index, revealed that only low RF muscle thickness increased the risk of grade 3–4 neutropenia by 9.210 times (95% CI = 2.401–35.326, p = 0.001). Utilizing US to measure RF muscle thickness aids in identifying cancer patients at an elevated risk of developing neutropenia. Needless to say, US can serve as a convenient and easily accessible tool for assessing low SMM, providing repeat point-of-care evaluations in clinical practice

Can We Predict the Surgical Margin Positivity in Patients Treated with Radical Prostatectomy? A Multicenter Cohort of Turkish Association of Uro-Oncology

Objective To analyze the parameters that predict the surgical margin positivity after radical prostatectomy for localized prostate cancer. Materials and Methods In this multicenter study, the data of 1607 consecutive patients undergoing radical prostatectomy for localized prostate cancer in 12 different clinics in Turkey between 1993-2011 were assessed. Patients who had neoadjuvant treatment were excluded. We assessed the relationship between potential predictive factors and surgical margin status after radical prostatectomy such as age, cancer characteristics, history of transurethral prostate resection, surgical experience and nerve-sparing technique by using univariate and multivariate Cox regression analyses and t test. Results The overall surgical margin positivity rate was 22.6% (359 patients). In univariate analyses, preoperative prostate specific antigen level, clinical stage, biopsy Gleason score, percentage of tumor involvement per biopsy specimen, transurethral prostate resection history, surgical experience and nerve-sparing technique were significantly associated with positive surgical margin rate. In multivariate analyses, preoperative prostate specific antigen level (OR: 1.03, p=0.06), percentage of tumor involvement per biopsy specimen (OR: 7,14, p<0,001), surgical experience (OR: 2.35, p=0.011) and unilateral nerve-sparing technique (OR: 1.81, p=0.018) were independent predictive factors for surgical margin positivity. Conclusion Preoperative prostate specific antigen level, percentage of tumor involvement per biopsy specimen, surgical experience and nerve-sparing technique are the most important predictive factors of surgical margin positivity in patients undergoing radical prostatectomy for localized prostate cancer

Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19