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

Aksilla tutulumu olmayan erken evre meme kanserli hastalarda, sentinel lenf nodu biyopsisinin güvenilirliğive etkinliğinin değerlendirilmesi

Amaç: Bu çalışmada klinik olarak aksilla negatif erken evre meme kanserli hastalarda sentinel lenf nodu biyopsisinin etkinliği araştırıldı. Yöntemin sen- tinel lenf nodunu bulma ve yanlış negatiflik oranları hesaplanarak erken evre meme kanserli hastalarda aksillanın değerlendirilmesinde sentinel lenf nodu biyopsisinin yerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Bu prospektif çalışma, erken evre meme kanseri tanısıyla Mart 2006 – Mart 2009 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda tedavi edilen 57 hastada yapıldı. Hastalar iki farklı gruba ayrıldı. Grup I’de 35 hastada mavi boya tekniği, Grup II’de 22 has- tada kombine teknik uygulandı. İnvaziv kanser saptanan 46 hastaya sentinel lenf nodu biyopsisi sonrası aksiller lenf nodu diseksiyonu yapıldı. Bulgular: Grup I’de 2 hastada, Grup II’de 1 hastada olmak üzere toplam 3 hastada sentinel lenf nodu saptanamadı. Sentinel lenf nodu bulma oranı tüm hastalar için %94,7 olup bu oran Grup I’de %94,2 , Grup II’de %95,4 idi. Yanlış negatiflik oranı Grup I’de %22,2 , Grup II’de %30 olup tüm hastalar için %26,3 idi. Tekniği öğrenme sürecindeki ilk 15 olgu değerlendirme dışı bırakıldığında tüm grupta sentinel lenf nodu bulma oranı %96,8’e yükselirken yanlış negatiflik oranı %0’a geriledi. Sonuç-Yorum: Bu çalışmada erken evre meme kanserli hastalarda aksillanın evrelemesinde sentinel lenf nodu biyopsisinin etkin ve güvenli bir yöntem olduğu belirlendi. Her merkezin yeterli deneyim kazanıncaya kadar, sentinel lenf nodu biyopsisi ile aksiller lenf nodu diseksiyonunu beraber yapmasının daha güvenli olacağı düşünüldü.Purpose: In this study, sentinel lymph node identification and false negative rates were calculated and determination of the place of sentinel lymph node biopsy in the evaluation of axilla in patients with early stage breast cancer was aimed. Materials and Methods: This prospective study was performed on 57 patients with early stage breast cancer who were treated at the Department of Sur- gery in Medical Faculty of Çukurova University between 2006-2009. Blue dye technique was performed in 35 (Group I ) and the combined technique was performed in 22 patients (Group II). Axillary lymph node dissection was per- formed after sentinel lymph node biopsy on 46 patients who have invasive breast cancer. Results: Sentinel lymph node was not detected in two patients in Group I and one in Group II. Sentinel lymph node identification rate was 94.7% for all pa- tients, and it was 94.2% in Group I and 95.4% in Group II. False negative rate was 26.3% for all patients which was 22.2% in Group I and 30.0% in Group II. Sentinel lymph node identification rate was increased to 96.8% and false negative rate decreased to 0% when the first 15 patients within the learning period was excluded from the statistical analysis. Conclusion: Sentinel lymph node biopsy is a safe and effective technique on staging of axilla in patients with early stage breast cancer. Nevertheless, every medical center should perform sentinel lymph node biopsy and axillary lymph node dissection together untill getting experienced

Endotoxin-induced bacterial translocation in splenectomized rats

Amaç: Bu deneysel çalışma endotoksinle uyarılan bakteriyel translokasyona (BT) splenektominin etkisini belirlemek amacıyla yapıldı. Genel Bilgi: İntraperitoneal uygulanan endotoksinin enterik bakteriyel translokasyona neden olduğu yapılan çalışmalarda gösterilmiştir. Az sayıdaki çalışmalarda splenektominin bakteriyel translokasyonu değişik mekanizmalarla azalttığı açıklanmıştır. Yöntemler: Altmış Wistar-Albino sıçan altı eşit gruba ayırıldı. Deneklere splenektomi veya sham splenektomi yapıldı. Yedi gün sonra 1 mi (5 mg/kg) Escherichia Coli 0111:84 endotoksini veya serum fizyolojik intraperitoneal olarak verildi. Endotoksin verildikten 24 saat sonra bakteriyel translokasyon araştırıldı. Bulgular: Endotoksinle uyarılan bakteriyel translokasyon sıklığı, öpere edilmeyen grupta %77.7, sham splenektomi yapılan grupta %80, splenektomi grubunda ise %30 olarak bulundu. Endotoksinle uyarılan bakteriyel translokasyon sıklığı, öpere edilmeyen ve sham splenektomi yapılan grupta splenektomi yapılan gruba göre önemli oranda yüksek bulundu (p<0,05). Histopatolojik incelemede splenektomi yapılan sıçanlarda ileumun normal mukoza yapısını koruduğu saptandı. Sonuçlar: Splenektominin endotoksinle uyarılan bakteriyel translokasyonu azalttığı belirlendi.Objective: The purpose of the experimental study was to determine the effect of splenectomy on the incidence of endotoxin-induced bacterial translocation (BT) in rats. Background Data: The studies were documanted that intraperitoneal endotoxin administration causes enteric bacterial translocation. A few studies were demonstratedthat splenectomy reduced the incidence of BT by different mechanisms. Methods: Sixty Wistar-Albino rats were divided six groups equally. Experiments underwent splenectomy or sham-splenectomy. On postoperative day 7, all rats received an intraperitoneal administration (1 ml) of Escherichia Coli 0111:64 endotoxin (5 mg/kg) or saline. Bacterial translocation was measured 24 hours after endotoxin administration. Results: The incidence of endotoxin-induced BT was 77.7% in the unoperated group, 80% in the sham-splenectomy group and 30% in the splenectomy group. The incidence of endotoxin-induced BT was significantly higher in the groups with unoperated plus endotoxin administration and sham splenectomy plus endotoxin adminstiration than splenectomy plus endotoxin administration group (<0,05). Histopathological examination of the ileum revealed a preserved normal mucosa architecture in splenectomized rats

The Impact of Migraine on Posterior Ocular Structures

properly cited. Purpose. To investigate the thickness of the retinal nerve fiber layer (RNFL) and choroid in patients who have migraines in comparison to healthy controls. Methods. This study included 76 eyes and patients in the migraine group, 36 with aura (MWA group) and 40 without (MWoA group), and 38 eyes as control subjects. The RNFL and macular thicknesses were analysed with standard OCT protocol while choroidal thickness was analysed with EDI protocol in all subjects. Choroidal thickness was measured at the fovea, 1500 m nasal and 1500 m temporal to the fovea in a horizontal section. Results. The mean RNFL thickness for nasal and nasal inferior sectors was significantly thinner ( ≤ 0.018) in the migraineurs&apos; eyes than in those of the controls, as was the mean choroid thickness at the fovea and measured points ( &lt; 0.0001). However, the mean macular thickness was not significantly different between the groups. Conclusions. This study suggests that migraine leads to a reduction in the peripapillary RNFL thickness and to thinning in choroidal structures. These findings can be explained by a chronic ischemic insult related to migraine pathogenic mechanisms and these findings are considered supportive of the relationship between glaucoma and migraine

The Impact of Migraine on Posterior Ocular Structures

Purpose. To investigate the thickness of the retinal nerve fiber layer (RNFL) and choroid in patients who have migraines in comparison to healthy controls. Methods. This study included 76 eyes and patients in the migraine group, 36 with aura (MWA group) and 40 without (MWoA group), and 38 eyes as control subjects. The RNFL and macular thicknesses were analysed with standardOCT protocolwhile choroidal thicknesswas analysed with EDI protocol in all subjects. Choroidal thicknesswas measured at the fovea, 1500 rho m nasal and 1500 mu m temporal to the fovea in a horizontal section. Results. The mean RNFL thickness for nasal and nasal inferior sectors was significantly thinner (P <= 0.018) in themigraineurs' eyes than in those of the controls, as was the mean choroid thickness at the fovea and measured points (P < 0.0001). However, themeanmacular thickness was not significantly different between the groups. Conclusions. This study suggests that migraine leads to a reduction in the peripapillary RNFL thickness and to thinning in choroidal structures. These findings can be explained by a chronic ischemic insult related to migraine pathogenic mechanisms and these findings are considered supportive of the relationship between glaucoma and migraine

The Impact of Migraine on Posterior Ocular Structures

Purpose. To investigate the thickness of the retinal nerve fiber layer (RNFL) and choroid in patients who have migraines in comparison to healthy controls. Methods. This study included 76 eyes and patients in the migraine group, 36 with aura (MWA group) and 40 without (MWoA group), and 38 eyes as control subjects. The RNFL and macular thicknesses were analysed with standard OCT protocol while choroidal thickness was analysed with EDI protocol in all subjects. Choroidal thickness was measured at the fovea, 1500 µm nasal and 1500 µm temporal to the fovea in a horizontal section. Results. The mean RNFL thickness for nasal and nasal inferior sectors was significantly thinner (P≤0.018) in the migraineurs’ eyes than in those of the controls, as was the mean choroid thickness at the fovea and measured points (P<0.0001). However, the mean macular thickness was not significantly different between the groups. Conclusions. This study suggests that migraine leads to a reduction in the peripapillary RNFL thickness and to thinning in choroidal structures. These findings can be explained by a chronic ischemic insult related to migraine pathogenic mechanisms and these findings are considered supportive of the relationship between glaucoma and migraine