Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

Background: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.Fil: Efe, Cumali. Harran University Hospita; TurquíaFil: Lammert, Craig. University School of Medicine Indianapolis; Estados UnidosFil: Taşçılar, Koray. Universitat Erlangen-Nuremberg; AlemaniaFil: Dhanasekaran, Renumathy. University of Stanford; Estados UnidosFil: Ebik, Berat. Gazi Yasargil Education And Research Hospital; TurquíaFil: Higuera de la Tijera, Fatima. Hospital General de México; MéxicoFil: Calışkan, Ali R.. No especifíca;Fil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Gerussi, Alessio. Università degli Studi di Milano; ItaliaFil: Massoumi, Hatef. No especifíca;Fil: Catana, Andreea M.. Harvard Medical School; Estados UnidosFil: Purnak, Tugrul. University of Texas; Estados UnidosFil: Rigamonti, Cristina. Università del Piemonte Orientale ; ItaliaFil: Aldana, Andres J. G.. Fundacion Santa Fe de Bogota; ColombiaFil: Khakoo, Nidah. Miami University; Estados UnidosFil: Nazal, Leyla. Clinica Las Condes; ChileFil: Frager, Shalom. Montefiore Medical Center; Estados UnidosFil: Demir, Nurhan. Haseki Training And Research Hospital; TurquíaFil: Irak, Kader. Kanuni Sultan Suleyman Training And Research Hospital; TurquíaFil: Melekoğlu Ellik, Zeynep. Ankara University Medical Faculty; TurquíaFil: Kacmaz, Hüseyin. Adıyaman University; TurquíaFil: Balaban, Yasemin. Hacettepe University; TurquíaFil: Atay, Kadri. No especifíca;Fil: Eren, Fatih. No especifíca;Fil: Alvares da-Silva, Mario R.. Universidade Federal do Rio Grande do Sul; BrasilFil: Cristoferi, Laura. Università degli Studi di Milano; ItaliaFil: Urzua, Álvaro. Universidad de Chile; ChileFil: Eşkazan, Tuğçe. Cerrahpaşa School of Medicine; TurquíaFil: Magro, Bianca. No especifíca;Fil: Snijders, Romee. No especifíca;Fil: Barutçu, Sezgin. No especifíca;Fil: Lytvyak, Ellina. University of Alberta; CanadáFil: Zazueta, Godolfino M.. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Demirezer Bolat, Aylin. Ankara City Hospital; TurquíaFil: Aydın, Mesut. Van Yuzuncu Yil University; TurquíaFil: Amorós Martín, Alexandra Noemí. No especifíca;Fil: De Martin, Eleonora. No especifíca;Fil: Ekin, Nazım. No especifíca;Fil: Yıldırım, Sümeyra. No especifíca;Fil: Yavuz, Ahmet. No especifíca;Fil: Bıyık, Murat. Necmettin Erbakan University; TurquíaFil: Narro, Graciela C.. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Bıyık, Murat. Uludag University; TurquíaFil: Kıyıcı, Murat. No especifíca;Fil: Kahramanoğlu Aksoy, Evrim. No especifíca;Fil: Vincent, Maria. No especifíca;Fil: Carr, Rotonya M.. University of Pennsylvania; Estados UnidosFil: Günşar, Fulya. No especifíca;Fil: Reyes, Eira C.. Hepatology Unit. Hospital Militar Central de México; MéxicoFil: Harputluoğlu, Murat. Inönü University School of Medicine; TurquíaFil: Aloman, Costica. Rush University Medical Center; Estados UnidosFil: Gatselis, Nikolaos K.. University Hospital Of Larissa; GreciaFil: Üstündağ, Yücel. No especifíca;Fil: Brahm, Javier. Clinica Las Condes; ChileFil: Vargas, Nataly C. E.. Hospital Nacional Almanzor Aguinaga Asenjo; PerúFil: Güzelbulut, Fatih. No especifíca;Fil: Garcia, Sandro R.. Hospital Iv Víctor Lazarte Echegaray; PerúFil: Aguirre, Jonathan. Hospital Angeles del Pedregal; MéxicoFil: Anders, Margarita. Hospital Alemán; ArgentinaFil: Ratusnu, Natalia. Hospital Regional de Ushuaia; ArgentinaFil: Hatemi, Ibrahim. No especifíca;Fil: Mendizabal, Manuel. Universidad Austral; ArgentinaFil: Floreani, Annarosa. Università di Padova; ItaliaFil: Fagiuoli, Stefano. No especifíca;Fil: Silva, Marcelo. Universidad Austral; ArgentinaFil: Idilman, Ramazan. No especifíca;Fil: Satapathy, Sanjaya K.. No especifíca;Fil: Silveira, Marina. University of Yale. School of Medicine; Estados UnidosFil: Drenth, Joost P. H.. No especifíca;Fil: Dalekos, George N.. No especifíca;Fil: N.Assis, David. University of Yale. School of Medicine; Estados UnidosFil: Björnsson, Einar. No especifíca;Fil: Boyer, James L.. University of Yale. School of Medicine; Estados UnidosFil: Yoshida, Eric M.. University of British Columbia; CanadáFil: Invernizzi, Pietro. Università degli Studi di Milano; ItaliaFil: Levy, Cynthia. University of Miami; Estados UnidosFil: Montano Loza, Aldo J.. University of Alberta; CanadáFil: Schiano, Thomas D.. No especifíca;Fil: Ridruejo, Ezequiel. Universidad Austral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Wahlin, Staffan. No especifíca

Topal Osman Ağa'nın hayatı ve bibliyografisi

Topal Osman Ağa sıra dışı kişiliği, faaliyetleri ve adının geçtiği olaylarla yaşadığı dönemin merak edilen simalarından biri olmuştur. Mustafa Kemal Paşa’nın korumasını üstlenen Türkiye Büyük Millet Meclisi Riyaset Muhafız Bölüğü, Giresun’da gönüllülerden teşkil edilen 42 ve 47. Alayların kurulmasında etkili olmuş, Giresun Belediye Başkanlığı ve 47. Alay Komutanlığı yapmıştır. Kırk yıllık ömrünün önemli bir kısmını tabiri yerindeyse savaş meydanlarında geçiren Osman Ağa, Balkan Savaşı gazisi olmasına rağmen gönüllü olarak sırasıyla Birinci Dünya Savaşı, iç isyanlar (Pontus ve Koçgiri Ayaklanmaları), Sakarya Meydan Muharebesi ve Büyük Taarruza katılmış, gösterdiği başarılara nişanen milis yarbay rütbesine kadar yükselmiş ve İstiklal Madalyası ile ödüllendirilmiştir. Lozan görüşmeleri sırasında gerçekleşen Trabzon Mebusu Ali Şükrü Bey cinayetinin zanlısı olduğu iddia edilmiş, 2 Nisan 1923 tarihinde çatışma sırasında öldürülmüştür. Bu çalışmada belge ve hatıratlar ışığında Topal Osman Ağa’nın hayat hikayesinin ele alınması ve konu hakkındaki yayınlar incelenerek bir bibliyografya hazırlanması amaçlanmıştır

Prospective evaluation of chronic ambulatory peritoneal dialysis patients in terms of sleep quality, quality of life and depression

PD hastalarında uyku kalitesini etkileyen faktörleri ve bu hastalardaki yaşam kalitesi, uyku kalitesi ve depresyon ile mortalite ve peritonit sıklığı arasındaki ilişkiyi inceledik.Materyal-Metod : Çalışmaya Selçuk Üniversitesi Meram Tıp Fakültesi Periton Diyalizi polikliniğinde takibi yapılan 124 hasta alındı. Hastalara çalışma başlangıcında ve bir yıllık takip sonunda PUKİ, SF-36 ve BDÖ değerlendirme formları uygulandı. Hastaların bu sürede geçirmiş olduğu peritonit atakları ve ölüm nedenleri kayıt edildi.Bulgular : Çalışma başlangıcındaki değerlendirme sonunda hastalardan 70 tanesinin (%56.5) iyi uyku kalitesine, 54 tanesinin (%43.5) kötü uyku kalitesine sahip oldukları izlendi. Kötü uyku kalitesine sahip olan hastalarda, iyi uyku kalitesi olanlarla karşılaştırıldığında daha yüksek BDÖ skoru, daha yüksek depresyon oranı, daha kötü yaşam kalitesi, daha ileri yaş ve daha az periton diyaliz süresi olduğu tespit edildi. Buna ek olarak yüksek okul mezunlarında, iyi uyku kalitesi önemli oranda daha yüksek bulundu. Multivaryant analizde hastaların kötü uyku durumunu gösterebilecek tek bağımsız risk faktörü BDÖ skoru olarak bulundu.Hastalardan 4'ü kardiyovasküler hastalıktan, 2'si enfeksiyondan, 1'i maligniteden ve 1'i de bilinmeyen bir sebepten dolayı olmak üzere toplam 8 tanesinin bir yıl sonunda öldüğü tespit edildi. Mortalite ile ilişkili faktörler incelendiğinde bunların, ileri yaş, komorbidite varlığı, hipoalbuminemi, yaşam kalitesi komponentlerinin (FKS ve MKS) kötü olması ve yüksek depresyon skoru olduğu görüldü.Çalışmanın sonunda halen periton diyalizine devam edenlerden 71 hastanın hiç peritonit atağı geçirmediği, 12 hastanın 1 kez, 12 hastanın 2 kez ve 1 hastanın 3 kez olmak üzere toplam 39 peritonit tablosu izlendi. Bu da yaklaşık 29.5 hasta ayında bir peritonit tablosu ile karşılaşıldığını gösteriyor. Peritonit geçiren ve geçirmeyen hastaların başlangıçtaki depresyon, uyku kalitesi ve yaşam kalitesi skorları karşılaştırıldığında PUKİ, FKS, MKS ve BDÖ skorları ile peritonit sıklığı arasında istatistiksel olarak anlamlı bir ilişki tespit edilemedi.Sonuç: Depresyon ve/veya uyku şikayeti olan diyaliz hastalarında psikiyatrik değerlendirme ve müdahale gereklidir. Ayrıca PD hastalarında mortalite ile ilişkili olan yaşam kalitesi ve depresyon belli aralıklarla değerlendirilmeli ve daha iyi yaşam kalitesini sağlamak için çaba gösterilmelidir.We investigated factors affecting sleep quality and relation between quality of life, sleep quality, depression and mortality and frequency of peritonitis in PD patients.Material-Method : We included 124 patients who were undergoing PD at Selcuk University Meram Faculty of Medicine Peritoneal Dialysis Outpatient Clinic. PSQI, SF-36 ve BDI survey questionnaires were applied to patients both at study initiation and after 1 year follow-up. We recorded peritonitis episodes and causes of mortality during this period.Results : We found that based on the initial evaluation that 70 patients (% 56.5) had good sleep quality whereas 54 (% 43.5) patients had poor sleep quality. When patients who had poor sleep compared to patients who had good sleep, formers were older, had higher BDI score, higher depression rate, poorer quality of life and shorter time on dialysis. In addition to this, sleep quality was significantly better in high school graduates. Multivariate analysis showed that the only independent variable associated with poor sleep quality was BDI score.Totaly 8 patients died during the observation period. Reasons for death in these patients were as follows; cardiovascular disease in 4, infection in 2, malignity in one and undetermined reason in one patients. Factors related to mortality were advanced age, presence of comorbidity, hypoalbuminemia, poor components of quality of life (MCS and PSC) and higher depression score.At the end of the study, 71 patients never had peritonitis episode, 12 patients had only one episode, 12 patients had 2 episodes and 1 patient had 3 episodes. The number of total peritonitis episodes observed were 39. This coincide approximately one peritonitis for each 29.5 patient-months. When baseline depression, sleep quality and quality of life scores of patients who had and had not peritonitis were compared , there was not a statistically significant relation between PSQI, PCS, MCS and BDI scores and peritonitis frequency. Conclusion: Psychiatric evaluation and intervention are required in patients who have depression and/or sleep complaints. In addition, quality of life and depression, which are related to mortality in PD patients, should be evaluated regularly and every effort should be exercised to provide better quality of life

Serum ischemic modified albumin (IMA) concentration and IMA/albumin ratio in patients with hepatitis B-related chronic liver diseases

Background/aim: Albumin is the most important protein synthesized by the liver. Posttranscriptional changes occur in the molecular structure of albumin due to various factors and isoforms arise. Ischemic modified albumin (IMA) is one such isoform. This study was conducted to evaluate serum IMA concentrations in patients with hepatitis B virus (HBV)-related chronic liver diseases. Materials and methods: This study included 74 treatment-naive chronic hepatitis B patients, 25 patients with HBV-related cirrhosis, and 49 healthy controls. Serum IMA concentration was measured spectrophotometrically using the albumin cobalt binding test. Results: The mean IMA concentrations in the chronic hepatitis B group and healthy controls were 0.33 ± 0.11 ABSU and 0.27 ± 0.70 ABSU, respectively, and the difference was statistically significant (P > 0.001). Mean IMA/albumin ratios (IMAR) in the chronic hepatitis B and control groups were 0.08 ± 0.04 and 0.06 ± 0.17, respectively, and the difference was also statistically significant (P > 0.001). Higher serum IMA concentrations and IMAR were detected in patients with advanced fibrosis. Conclusion: Serum IMA concentration and IMAR are increased in patients with HBV-related chronic liver diseases and IMA and IMAR are associated with the degree of liver fibrosis. IMA and IMAR may have potential use as noninvasive markers of fibrosis in chronic hepatitis B patients

KDIGO (Kidney Disease: Improving Global Outcomes) Criteria As a Predictor of Hospital Mortality in Cirrhotic Patients

Background/Aims: Acute kidney injury (AKI) is frequent in cirrhotic patients and is associated with a poor prognosis. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) organization recommended new criteria for the diagnosis and staging for AKI. The aim of this study was to evaluate the presence of AKI according to KDIGO criteria in cirrhotic patients admitted to the hospital and to determine its association with hospital mortality.Materials and Methods: This retrospective study included 277 cirrhotic patients admitted to the intensive care unit and gastroenterology service of a tertiary referral hospital from January 2008 to January 2012. AKI was diagnosed and classified according to the KDIGO criteria.Results: The overall incidence of AKI in cirrhotic patients was 39%, and the overall hospital mortality was 15.5%. Patients without AKI had a hospital mortality rate of 2.4%, whereas the mortality rate for patients with AKI was 36.1%. The peak AKI stage detected during hospitalization was stage 1 for 58 patients (53.7%), stage 2 for 20 patients (18.5%), and stage 3 for 30 patients (27.7%). Mortality was found to be associated with the presence, stage, and progression of AKI. Multivariate analysis showed that AKI was an independent factor significantly associated with mortality (odds ratio: 9.1; 95% confidence interval: 2.89-29.1; p>0.001).Conclusion: KDIGO criteria can be used to evaluate AKI in cirrhotic patients. The prevalence of AKI in patients with cirrhosis is high, and AKI is associated with mortality. If early preventive measures are taken, it may be possible to prevent AKI progression and thus mortalit

Dynamic thiol-disulfide homeostasis is disturbed in hepatitis B virus-related chronic hepatitis and liver cirrhosis

WOS:000452889200014PubMed ID: 30384565Background/aim: Thiol-disulfide homeostasis is an important antioxidant defense mechanism. This study was conducted to investigatedynamic thiol-disulfide homeostasis in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis.Materials and methods: Seventy-one treatment-naive patients with chronic hepatitis B (CHB), 50 patients with hepatitis B virusassociated liver cirrhosis, and 45 healthy controls were included in the study. Serum total and native thiol concentrations and serumdisulfide concentrations were measured using an automated method.Results: Mean serum total thiol concentrations in the control, CHB, and cirrhosis groups were 481.64 37.87 µmol/L, 438.50 71.35µmol/L, and 358.07 80.47 µmol/L, respectively (P 0.001), and mean serum native thiol concentrations in the control, CHB, andcirrhosis groups were 452.92 36.43 µmol/L, 400.16 65.92 µmol/L, and 328.15 74.91 µmol/L, respectively (P 0.001). Mean serumdisulfide concentrations in the control, CHB, and cirrhosis groups were 14.38 3.38 µmol/L, 19.19 6.16 µmol/L, and 14.98 5.53µmol/L, respectively (P 0.001). There was a progressive decrease in both mean serum native and total thiol concentrations parallel tothe liver fibrosis stage.Conclusion: : Thiol-disulfide homeostasis is disturbed in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis

Rectal or intramuscular diclofenac reduces the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography

WOS:000378646700017PubMed ID: 27513404Background/aim: Acute pancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography (ERCP). We aimed to evaluate the efficacy of intramuscular diclofenac sodium for prophylaxis of post-ERCP pancreatitis (PEP) in comparison to the rectal form. Materials and methods: One hundred and fifty consecutive patients who underwent ERCP were enrolled in this single-center, prospective, randomized controlled study. Patients were randomized into three groups. The first group received 75 mg of diclofenac sodium via intramuscular route and the second group received 100 mg of diclofenac sodium rectally 3090 min before the procedure. The third group served as the control group. Patients were evaluated for post-ERCP pancreatitis with serum amylase levels and abdominal pain 24 h after the procedure. Results: The overall incidence of PEP was 6% (n 9) and 2% (n 1) in the intramuscular (IM) and rectal groups, respectively, and 14% in the control group (P 0.014). Nineteen (12.7%) patients developed post-ERCP abdominal pain (8% in IM, 10% in rectal, and 20% in control group; P 0.154). Twenty-five (16.6%) patients developed post-ERCP hyperamylasemia (10% in IM, 12% in rectal, and 24% in control group; P 0.03). Conclusion: Prophylaxis with diclofenac given rectally or intramuscularly is an effective option for the management of post-ERCP pancreatitis

Üst Gastrointestinal Endoskopi İşlemi Öncesi HBsAg, Anti HCV ve Anti HIV Prevalansları

Amaç: Bu çalışma dispeptik yakınmalar ile başvuran ve üst gastrointestinal endoskopi incelemesi önerilen hastalarda yapıldı. Çalışmanın amacı endoskopi işlemi öncesi hastalarda hepatit serolojisi ve Anti HIV serolojisini taramak ve prevalansını değerlendirmek, bunun sonucunda işlem öncesinde rutin seroloji isteminin gerekliliğini tartışmaktır. Gereç ve Yöntemler: Çalışma 2012 yılında Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji polikliniğine başvuran ve işlem öncesi hepatit ve HIV serolojisi bakılan toplam 242 hastayı kapsamaktadır. Bulgular: Çalışmaya alınan toplam 242 hastanın; 120si erkek (%49), 122si kadın (%50) idi. Seropozitiflik oranları HBsAg %2,9, Anti HCV %0,4 iken Anti HIV pozitifliğine rastlanmadı. Toplamda hastaların %3,3 de hepatit serolojisi pozitif tespit edildi. Sonuç: Hastanemizde endoskopi işlemi öncesi bakılan hepatit serolojisi oranlarının toplum prevalansına yakın değerlerde çıktığı görülmüştür, endoskopik işlemler sonrası hepatit bulaşının son derece nadir olduğu da göz önüne alınırsa endoskopi ünitelerinde yeterli dezenfeksiyon uygulamalarına riayet edilmesi takdirinde rutin serolojik testlerin gereksiz olduğu kanısına ulaşılmaktadır.Objectıve: This study was conducted to determine the preprocedure prevalence of hepatitis B, hepatitis C and HIV in patients with dyspeptic complaints to whom an upper gastrointestinal endoscopy was performed and also to question the necessity of routine serologic testing. Materials and Methods: Medical records of 242 adult patients who applied to Gastroenterology clinic of Necmettin Erbakan University Meram Faculty of Medicine with dyspeptic complaints during 2012 and to whom an upper gastrointestinal endoscopy was performed were analyzed retrospectively for preprocedure hepatitis B, hepatitis C and HIV serologies. Results: A total of 242 patients were taken into the study. 120 of them (49%) were males and 122 of them (51%) were females. Preprocedure prevalence of HBs Ag and anti HCV was 2.9% and 0.4% respectively. Anti HIV was detected to be positive in none of the patients. In total 3.3% of patients were positive hepatitis serology. Conclusion: The preprocedure prevalence of hepatitis B and C in our patients was consistent with the prevalences reported for general population in previous studies. Taken into account that post procedure transmission of hepatitis B and C is rare, routine serologic testing is not necessary as far as disinfection rules are obeyed strictly in endoscopy clinics