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

Predictive role of perfectionism on depressive symptoms and anger: negative life events as the moderator

M.S. - Master of Scienc

A Frontotemporal Dementia with Epilepsia Parsiyalis Continua Responding Lacozamid Treatment

Seizures may occur in frontotemporal lobar degeneration syndromes as an element of a heterogeneous group of disorders, according to both clinical phenotype and neuropathology. Although electroencephalography results are abnormal in frontotemporal lobar degeneration syndromes, epileptic seizures are rarely reported. A better understanding of the pathogenesis of dementia may shed light on the mechanisms of epileptogenesis and may facilitate more rational approaches to seizure treatment. The treatment of seizures in dementia syndromes is still empiric. Epilepsia partialis continua (EPC) is included in the 2001 International League Against Epilepsy (ILAE) classification as a continuous type of seizure. According to the 2017 ILAE classification, the present patient’s seizure was defined as a focal onset, preserved consciousness, focal motor, clonic seizure. The onset of epilepsia partialis continua is usually a bad predictor of progressive disease. Furthermore, there is often a failure to respond to combined high dose antiepileptics, regardless of the underlying cause

15 Yaşın Altındaki Çocuklar Arasında Cinsel İlişki Olgu Sunumu

Ülkemizde çocukların cinsel sağlık ve cinsel davranışlarla ile ilgili bilgileri yetersizdir. Sunulan olguda 15 yaşından küçük iki çocuğun, birbirleri ile cinsel etkileşimleri hakkındaki ve adli sürecin tartışılması amaçlanmıştır. Çocuklara cinsel davranışlar ile ilgili eğitim verilmesi önemlidir. Çocukluk çağı için, konunun uzmanlarından görüş alınarak, cinsel davranışlar ile ilgili ayrıntılı yasal düzenleme yapılması gerektiği düşünülmektedir. Anahtar Kelimler: Çocuklar arası. Cinsellik, Çocuk, Adli Tıp

Raeder’s Syndrome “Paratrigeminal Neuralgia” Beyond Headache: A Case Report

Raeder’s syndrome (paratrigeminal neuralgia), which sometimes radiates to the maxillary section, is defined as a constant and unilateral pain in the distribution area of the ophthalmic branch of the trigeminal nerve accompanied by Horner’s syndrome and caused by a defect in the carotid artery or in the middle cranial fossa. Although Raeder’s syndrome is accompanied with the irritation of the trigeminal nerve, it can be easily confused with Horner’s syndrome and mistakenly called “painful Horner’s syndrome”. This picture, which contains incomplete Horner’s syndrome with orbital pain and without anhydrosis, is an important clinical entity because it shows the location of the lesion and is different from the etiologic and prognostic perspective. Due to these reasons, we wanted to present a patient who was diagnosed as having paratrigeminal oculosympathetic Raeder syndrome in our clinical department of neurology to draw attention to differences in underlying resemblance to Horner’s syndrom

Evaluation of Seizure After Stroke in Stroke Unit

Objective: Patients with stroke may experience epileptic seizures as acute phase (usually defined as the first 15 days) or late phase complications. Risk factors are young age, male sex, cortical involvement and hemorrhagic transformation. Our aim was to investigate the etiologic factors and to determine the high-risk groups for the 1 year seizure rate of patients who are followed up in our clinic with a diagnosis of acute ischemic stroke. Materials and Methods: This study was included in a retrospective review of 299 patients who underwent regular out-patient clinic visits for 1 year followed by a diagnosis of acute ischemic stroke in the Department of Neurology at the Eskisehir Osmangazi University Faculty of Medicine between January 1st, 2012, and January 1st, 2015. Results: We found that thrombolytic therapy in patients with ischemic stroke decreased post-stroke seizure (p=0.043), whereas decompressive craniectomy (p=0.048), endovascular treatment (p=0.032), and cortical involvement (p=0.003) increased post-stroke seizures. Conclusion: According to our study, patients with cortical involvement, modified Rankin Scale score 4 and 5 at discharge, presence of major vascular occlusion treated with endovascular treatment, and those with decompressive craniectomy were high-risk groups. Prospective observational drug trials can be performed because double-blind placebo drug studies are not possible in high-risk groups

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

Background Cerebral venous sinus thrombosis (CVST) is not as well understood as an ischemic stroke of arterial origin. Although the prognosis of CVST is usually good, parenchymal lesions may occur in some patients, and the development of intracranial herniation may result in death. For this reason, recognizing the risk factors for intracranial herniation and accurately determining those patients who should undergo decompressive craniectomy is important. Objective This study aims to determine the risk factors for intracranial herniation in patients with CVST. Methods A total of 177 patients diagnosed with CVST between 2015 and 2021 in our tertiary center were retrospectively included in this study. Results Of the 177 patients, 124 were female and 53 were male with mean ages of 40.65 ± 13.23 and 44.13 ± 17.09, respectively. Among those, 18 patients had developed intracranial herniation. A significant statistical relationship was observed between superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, presence of malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis. The binary logistic regression analysis results showed that the most significant variables were the venous collateral score of 0, malignancy, and small juxtacortical hemorrhages. Conclusion This study identified small juxtacortical hemorrhages, the presence of malignancy, and a venous collateral score of 0 to be independent risk factors for intracranial herniation in CVST patients. Drawing on these results, we recommend close clinical observation of CVST patients, as they may be candidates for decompressive craniectomy