A rare cause of non-cirrhotic portal hypertension: primary antiphospholipid syndrome

The antiphospholipid syndrome involves long-term persistence of serum antiphospholipid antibodies and hypercoagulability manifested by venous or arterial thrombosis, recurrent pregnancy loss or thrombocytopenia. Two forms have been described: the “primary syndrome” where there is no evidence of an underlying disease, and the “secondary syndrome”, mainly in the setting of systemic lupus eryhematosus. Classic features of antiphospholipid syndrome include cutaneous signs, such as livedo reticularis, splinter hemorrhages, superficial thrombophlebitis, and leg ulcers; venous thrombotic events, such as cerebral or retinal vein thrombosis; arterial thrombotic events, such as transient attacks or ischemic infarcts, recurrent spontaneous early-term abortions, and thrombocytopenia. Also various hepatic manifestations have been reported with antiphospholipid syndrome in literature, including Budd-Chiari syndrome, hepatic-veno-occlusive disease and occlusion of small hepatic veins, nodular regenerative hyperplasia and portal hypertension. Herein we present a case of non-cirrhotic portal hypertension associated with primary antiphospholipid syndrome which this coexisting is rarely seen in the literature

Vocal Fold Hyperplastic Lesions: an Evaluation of Surgical Outcome with Videolaryngostroboscopy

Background: Vocal fold hyperplastic lesions are premalignant lesions that can be treated effectively by removal of the lesions surgically. Aims: The aim of this study was to discuss the success of surgery in patients with vocal fold hyperplastic lesions in terms of preserving vibratory function by comparing the preoperative and postoperative videolaryngostroboscopy findings. Study Design: The medical charts and videolaryngostroboscopic recordings of patients diagnosed with hyperplastic lesions on the vocal folds were reviewed retrospectively. Methods: Twenty seven patients with unilateral lesions who underwent type1 subepithelial cordectomy were enrolled in the study. The videolaryngostroboscopic recordings were evaluated by three raters who were not the operating surgeon and who were blinded to the histology of patients. To evaluate the videolaryngostroboscopic findings, a form, which is a modification of criteria described by Hirano and Bless, was used. Preoperative and 6th month postoperative videolaryngostroboscopic recordings were compared with each other and with recordings of the control group, which included 50 healthy volunteers. Results: All videolaryngostroboscopic findings, except false cord vibration, were significantly improved after surgery. Conclusion: The principle of vocal fold surgery in patients with benign lesions is to preserve the vibratory tissue. This principle also applies to patients with hyperplastic lesions that are premalignant. The hydrodissection technique may be beneficial for this purpose

Effort allocation for rewards in first-episode psychosis and first-episode mania

Background: Effort-based decision-making has been shown to be impaired inpatients with schizophrenia. Motivational deficits can also be seen in bipolardisorder given the growing evidence of phenomenological, biological, and genetic overlaps between schizophrenia spectrum disorders and bipolar disorder.This study aimed to evaluate the effort for reward in subjects who had the firstepisode of psychosis (FEP), the variation of this effort according to the size andprobability of reward; and to compare the changes in the effort for the rewards inpatients with the first episode of mania (FEM), and healthy control groups. Wealso aimed to assess whether these deficits in the willingness to expend effort forrewards are related to negative symptoms, positive symptoms, thought disorder,global cognition, and medication.Methods: In this study, effort-based decision-making was compared in patientswith the FEP (n¼53), the FEM (n¼45), and the healthy controls (n¼37). Effortbased decision-making has been evaluated using Effort-Expenditure for RewardsTask( EEfRT). This test evaluates individuals' efforts based on reward magnitudeand probability. Global cognition scores were calculated by a factor analysisbased on a comprehensive neurocognitive battery. Negative symptoms wereassessed with the Brief Negative Symptom Scale (BNSS). Positive symptoms wereevaluated with the Scale for the Assessment of Positive Symptoms (SAPS).Chlorpromazine equivalent doses were calculated for people having medicaltreatment.For EEfRT, the data were analyzed using a mixed model repeated measuresANOVA with the group as a between-subject factor and both probability andreward level (low, medium, high) as within-subjects factors.Results: The main effect for interaction between probability, reward, and thegroup was significant in EEfRT (F¼4,546 p&lt;0,001). Post hoc tests for therepeated measures ANOVA showed significant differences between patients withFEP and healthy controls, and between patients with FEM and healthy controls.In terms of the likelihood of hard task choices, conditions that differed betweengroups were medium probability-low reward (F¼6,02, p¼0,003), mediumprobability- high reward (F¼11,52, P&lt;0,001), high probability-medium reward(F¼15,01, p&lt;0,001), and high probability-high reward (F¼46,78, P&lt;0,001).Global cognition was associated with reduced effort only in high rewardmagnitude and high probability status in patients with FEP. The likelihood ofchoosing the hard task wasn’t correlated with medication, positive symptoms,negative symptoms, or thought disorder in patients with FEP and FEM. Inaddition, a significant difference was found between patients with FEP and FEMin uncorrected analysis in the high reward-high probability condition (p¼0,009).Conclusions: Deficits in the willingness to expend effort for rewards wereevident in FEP and FEM. Demonstration of motivational deficits in the sameprobability and reward situations in both groups may indicate a common pathophysiological mechanism in some subgroups of these disorders. The currentstudy reported cross-sectional evidence for decision-making abnormalities inschizophrenia and bipolar disorder. Further comparative research investigatinglongitudinal changes in effort-based decision-making in the early phases of bipolar and psychotic disorders is needed.</p

Evaluation of Dual Therapy in Real Life Setting in Treatment-Naïve Turkish Patients with HCV Infection: A Multicenter, Retrospective Study

Background: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients’ data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient’s demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients