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

Kronik viral hepatitler, karaciğer sirozu ve hepatosellüler karsinomada inflamasyon göstergesi olarak neopterin

Background and Aims: Neopterin is a proinflammatory indicator that plays a role in cell-mediated immunity, and elevated concentrations of neopterin indicate the presence of interferon-? in body fluids. In this study, neopterin concentrations were determined in patients with a virus-induced chronic liver disease (chronic hepatitis, liver cirrhosis, and hepatocellular cancer), inactive hepatitis B virus carriers, and in a healthy control group to assess whether neopterin can be used as a disease marker in patients with virus-induced chronic liver disease. Materials and Methods: A total of 110 subjects (42 females and 68 males, with an average age of 44±8.90 years) were included in this study. Of these patients, 33 had chronic hepatitis; 22, liver cirrhosis; 22, hepatoma; 18, inactive hepatitis B virus carriers; and 15 were included in the healthy control group. Neopterin levels were measured before and after interferon treatment in patients with chronic hepatitis. Data collected among the groups were analyzed statistically using the Mann-Whitney test, considering p < 0.05 as statistically significant. Results: Neopterin concentrations and gender showed no statistically significant correlation. Patients with cirrhosis, hepatocellular cancer, and chronic hepatitis had statistically significantly higher neopterin levels than the healthy control and healthy carrier groups. A positive correlation was observed between neopterin levels and other disease activity indicators such as aspartate transaminase, alanine transaminase, hepatitis B virus deoxyribonucleic acid, hepatitis C virus ribonucleic acid, erythrocyte sedimentation rate, and C-reactive protein levels, and their levels were also high. Although 14 patients, who were also evaluated after interferon treatment, showed good response to the treatment, no statistically significant correlation was observed between their neopterin levels and disease activity indicator levels. Conclusion: Neopterin concentrations were found to be significantly higher in patients with inflammation than in inactive hepatitis B virus carriers who had no ongoing inflammatory activity and in the healthy control group. No correlation was detected between neopterin levels and hepatitis B virus deoxyribonucleic acid and hepatitis C virus ribonucleic acid levels in patients who received interferon treatment and benefitted from it. Although neopterin levels indicate inflammatory activity in cases of chronic hepatitis, liver cirrhosis, and hepatocellular cancer, additional studies are necessary to determine its usefulness in clinical practice.iriş ve Amaç: Neopterin hücre aracılı immünitede rol oynayan proinflamatuvar bir belirleyicidir ve konsantrasyonu vücut sıvılarındaki ? interferonun varlığını gösterir. Viral etiyolojili karaciğer hastalığı olan kronik hepatit, karaciğer sirozu, hepatosellüler kanserli olgularda, inaktif hepatit B virüsü taşıyıcısı olanlarda neopterin seviyesini saptamak ve kontrol grubu ile karşılaştırarak; viral etiyolojili kronik karaciğer hastalıklarında yeri olabilecek bir belirteç olabileceğini ispatlamak amacıyla bu çalışma planlandı. Gereç ve Yöntem: Çalışmaya toplam 110 kişi (42 kadın, 68 erkek, yaş ortalaması 44±8.90) alındı. Bunlardan 33 hasta kronik hepatit, 22’si karaciğer sirozu, 22’si hepatoma, 18’i inaktif hepatit B taşıyıcısı ve 15’i sağlıklı kontrol grubu olarak belirlendi. Neopterin düzeyleri kronik hepatitli hastalarda interferon tedavisinden önce ve sonra ölçüldü. Gruplar arasındaki ölçümler istatistiksel olarak Mann-Whitney testiyle araştırıldı. p<0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Cinsiyet ve neopterin düzeyleri arasında istatistiksel olarak ilişki saptanmadı. Hastalıklar değerlendirildiğinde, neopterin seviyeleri siroz, hepatosellüler kanser, kronik hepatit grubundaki hastalarda sağlıklı taşıyıcı ve sağlıklı kontrol grubundaki hastalara göre istatistiksel olarak anlamlı düzeyde yüksekti. Neopterin düzeyleri, bu hasta gruplarında aktivite göstergeleri olan aspartat aminotransferaz, alanin aminotransferaz, hepatit B virüs deoksiribonükleik asit, hepatit C virüs ribonükleik asit, sedimentasyon ve C-reaktif protein değerleri ile arasında pozitif korelasyon vardı ve yüksek olarak saptandı. İnterferon tedavisi sonrası değerlendirilen 14 hastada ise tedaviye cevap alınmasına rağmen, neopterin düzeyleri ile aktivite belirteçleri arasında anlamlı ilişki saptanmadı. Sonuç: Sonuç olarak neopterin seviyeleri inflamasyonu olan hastalarda sağlıklı kontrol ve inflamasyon aktivitesi beklenmeyen hepatit B taşıyıcılarına göre anlamlı olarak daha yüksekti. İnterferon tedavisi verilen ve tedaviden fayda gören hastalarda hepatit B virüs deoksiribonükleik asit ve hepatit C virüs ribonükleik asit düzeyleri ile neopterin arasında bir korelasyon saptanmadı. Neopterin seviyesi kronik hepatit, karaciğer sirozu ve hepatosellüler kanserli olgularda inflamasyon aktivitesini gösterirken bunun klinik pratikteki yararı konusunda ilave çalışmalara gerek olduğu açıktır

Kronik viral hepatitler, karaciğer sirozu ve hepatosellüler karsinomada inflamasyon göstergesi olarak neopterin

Background and Aims: Neopterin is a proinflammatory indicator that plays a role in cell-mediated immunity, and elevated concentrations of neopterin indicate the presence of interferon-? in body fluids. In this study, neopterin concentrations were determined in patients with a virus-induced chronic liver disease (chronic hepatitis, liver cirrhosis, and hepatocellular cancer), inactive hepatitis B virus carriers, and in a healthy control group to assess whether neopterin can be used as a disease marker in patients with virus-induced chronic liver disease. Materials and Methods: A total of 110 subjects (42 females and 68 males, with an average age of 44±8.90 years) were included in this study. Of these patients, 33 had chronic hepatitis; 22, liver cirrhosis; 22, hepatoma; 18, inactive hepatitis B virus carriers; and 15 were included in the healthy control group. Neopterin levels were measured before and after interferon treatment in patients with chronic hepatitis. Data collected among the groups were analyzed statistically using the Mann-Whitney test, considering p < 0.05 as statistically significant. Results: Neopterin concentrations and gender showed no statistically significant correlation. Patients with cirrhosis, hepatocellular cancer, and chronic hepatitis had statistically significantly higher neopterin levels than the healthy control and healthy carrier groups. A positive correlation was observed between neopterin levels and other disease activity indicators such as aspartate transaminase, alanine transaminase, hepatitis B virus deoxyribonucleic acid, hepatitis C virus ribonucleic acid, erythrocyte sedimentation rate, and C-reactive protein levels, and their levels were also high. Although 14 patients, who were also evaluated after interferon treatment, showed good response to the treatment, no statistically significant correlation was observed between their neopterin levels and disease activity indicator levels. Conclusion: Neopterin concentrations were found to be significantly higher in patients with inflammation than in inactive hepatitis B virus carriers who had no ongoing inflammatory activity and in the healthy control group. No correlation was detected between neopterin levels and hepatitis B virus deoxyribonucleic acid and hepatitis C virus ribonucleic acid levels in patients who received interferon treatment and benefitted from it. Although neopterin levels indicate inflammatory activity in cases of chronic hepatitis, liver cirrhosis, and hepatocellular cancer, additional studies are necessary to determine its usefulness in clinical practice.iriş ve Amaç: Neopterin hücre aracılı immünitede rol oynayan proinflamatuvar bir belirleyicidir ve konsantrasyonu vücut sıvılarındaki ? interferonun varlığını gösterir. Viral etiyolojili karaciğer hastalığı olan kronik hepatit, karaciğer sirozu, hepatosellüler kanserli olgularda, inaktif hepatit B virüsü taşıyıcısı olanlarda neopterin seviyesini saptamak ve kontrol grubu ile karşılaştırarak; viral etiyolojili kronik karaciğer hastalıklarında yeri olabilecek bir belirteç olabileceğini ispatlamak amacıyla bu çalışma planlandı. Gereç ve Yöntem: Çalışmaya toplam 110 kişi (42 kadın, 68 erkek, yaş ortalaması 44±8.90) alındı. Bunlardan 33 hasta kronik hepatit, 22’si karaciğer sirozu, 22’si hepatoma, 18’i inaktif hepatit B taşıyıcısı ve 15’i sağlıklı kontrol grubu olarak belirlendi. Neopterin düzeyleri kronik hepatitli hastalarda interferon tedavisinden önce ve sonra ölçüldü. Gruplar arasındaki ölçümler istatistiksel olarak Mann-Whitney testiyle araştırıldı. p<0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Cinsiyet ve neopterin düzeyleri arasında istatistiksel olarak ilişki saptanmadı. Hastalıklar değerlendirildiğinde, neopterin seviyeleri siroz, hepatosellüler kanser, kronik hepatit grubundaki hastalarda sağlıklı taşıyıcı ve sağlıklı kontrol grubundaki hastalara göre istatistiksel olarak anlamlı düzeyde yüksekti. Neopterin düzeyleri, bu hasta gruplarında aktivite göstergeleri olan aspartat aminotransferaz, alanin aminotransferaz, hepatit B virüs deoksiribonükleik asit, hepatit C virüs ribonükleik asit, sedimentasyon ve C-reaktif protein değerleri ile arasında pozitif korelasyon vardı ve yüksek olarak saptandı. İnterferon tedavisi sonrası değerlendirilen 14 hastada ise tedaviye cevap alınmasına rağmen, neopterin düzeyleri ile aktivite belirteçleri arasında anlamlı ilişki saptanmadı. Sonuç: Sonuç olarak neopterin seviyeleri inflamasyonu olan hastalarda sağlıklı kontrol ve inflamasyon aktivitesi beklenmeyen hepatit B taşıyıcılarına göre anlamlı olarak daha yüksekti. İnterferon tedavisi verilen ve tedaviden fayda gören hastalarda hepatit B virüs deoksiribonükleik asit ve hepatit C virüs ribonükleik asit düzeyleri ile neopterin arasında bir korelasyon saptanmadı. Neopterin seviyesi kronik hepatit, karaciğer sirozu ve hepatosellüler kanserli olgularda inflamasyon aktivitesini gösterirken bunun klinik pratikteki yararı konusunda ilave çalışmalara gerek olduğu açıktır

An adult case of celiac sprue triggered after an ileal resection for perforated Meckel’s diverticulum

Celiac disease can be triggered by upper abdominal surgery, such as vagotomy, oesophagectomy, pancreaticoduodenectomy, and gastrojejunal anastomosis. Here we report a case of a 24 year-old woman who developed celiac disease after an ileal resection for perforated Meckel’s diverticula. This is the first reported celiac case that has been triggered, not by upper abdominal surgery, but after ileal resection for Meckel’s diverticula

Autophagy and anti-inflammation ameliorate diabetic neuropathy with Rilmenidine

ABSTRACT Purpose: To evaluate the neuroprotective effects of Rilmenidine on diabetic peripheral neuropathy (DPN) in a rat model of diabetes induced by streptozotocin (STZ). Methods: STZ (60 mg/kg) was administered to adult Sprague-Dawley rats to induce diabetes. On the 30th day after STZ administration, electromyography (EMG) and motor function tests confirmed the presence of DPN. Group 1: Control (n = 10), Group 2: DM + 0.1 mg/kg Rilmenidine (n = 10), and Group 3: DM + 0.2 mg/kg Rilmenidine (n = 10) were administered via oral lavage for four weeks. EMG, motor function test, biochemical analysis, and histological and immunohistochemical analysis of sciatic nerves were then performed. Results: The administration of Rilmenidine to diabetic rats substantially reduced sciatic nerve inflammation and fibrosis and prevented electrophysiological alterations. Immunohistochemistry of sciatic nerves from saline-treated rats revealed increased perineural thickness, HMGB-1, tumor necrosis factor-α, and a decrease in nerve growth factor (NGF), LC-3. In contrast, Rilmendine significantly inhibited inflammation markers and prevented the reduction in NGF expression. In addition, Rilmenidine significantly decreased malondialdehyde and increased diabetic rats’ total antioxidative capacity. Conclusions: The findings of this study suggest that Rilmenidine may have therapeutic effects on DNP by modulating antioxidant and autophagic pathways

Portal Hypertensive Polyps as Gastroscopic Finding in Liver Cirrhosis

Background. Portal hypertensive polyps in patients with portal hypertension are described. Aims. The most significant and serious complication in liver cirrhosis proves to be portal hypertension. Polypoid lesions, which can be seen in the stomach as endoscopic finding in patients with portal hypertension, have not quite been defined in the literature. The aim of this study, therefore, was to define polypoid lesion formation due to portal hypertension in the upper gastrointestinal system in patients with portal hypertension. Study Design. Cross-sectional study. Methods. The study covered a group of patients with liver cirrhosis and a healthy control group that did not have portal hypertension. All individuals covered by the study received upper GI endoscopy, while the endoscopic features and pathological characteristics of the identified polypoid lesions were defined. Standard histological criteria were used in polyp diagnosis. Results. A total of 400 individuals were included in the study. Upper GI endoscopy was performed for 200 patients with liver cirrhosis and another 200 healthy individuals with no portal hypertension in the control group. When the cases were gastroscopically assessed with regard to polypoid lesion presence, it was seen that a total of 87 (21.8%) individuals had polyps. While 67 (33.5%) cirrhotic patients were identified to have polyps, 20 (10%) individuals in the healthy control group had polyps. When the results of those with liver cirrhosis who received esophageal variceal endoscopic band ligation (EVL) and who did not were compared, it was observed that a higher number of individuals in the group with EVL had polypoid lesions. When the patient and control groups were compared as to Helicobacter pylori presence, the results showed that it was slightly higher in the dyspepsia group but the difference was not statistically significant (p>0.05). Conclusion. Portal hypertension-associated polypoid lesions are common in advanced liver cirrhosis cases. The pathological analyses of these polyps pointed out that they were all benign and no malignant cases were detected. It was argued that these polypoid lesions, referred to as portal hypertensive polyps, were associated with elevated angiogenesis in the gastric mucosa

Pregnancy outcomes of women with inflammatory bowel disease

Background: Inflammatory bowel diseases (IBD) generally affect women of childbearing age. In this study we investigated the effects of IBD on pregnancy, pregnancy outcomes and on newborns by comparing with a healthy control group. Methods: Data on the productive history were collected both in the question-and-answer format, and also from hospital records. The control group was made up of healthy volunteers of the same age group, who were living in the same region and who had a similar sociocultural structure. Control group data were also collected by asking questions on reproductive history in the question-and-answer format, and also from the obstetrical medical records. Results: The study was conducted on a total of 545 women, 219 of whom had ulcerative colitis (UC), 85 Crohn's disease (CD) and 241 healthy controls. The mean gestational age, birth weight and birth height of subjects in UC group was found to be significantly lower compared to the control group (p<0.05). Preterm birth was more common in UC and CD group, compared to the control group (p<0.01). No statistically significant difference was present between the groups with regard to abortion, and congenital anomalies. Cesarean section rate was higher in both UC and CD group than the control group (p<0.05). Conclusion: Gestation age, birth weight and height were low, whereas the preterm birth rate was higher in UC group. The rate of cesarean section was higher in both UC and CD groups, in those, who were diagnosed with disease during pregnancy, and also in women who became pregnant after disease diagnosis