Kronik hepatit B tedavisinde entekavir ve tenofovir kullanımının uzun dönem sonuçlarının retrospektif karşılaştırılması

Dünyada yaklaşık 400 milyon kişinin hepatit B virusu (HBV) ile enfekte olduğu tahmin edilmektedir. Bu hastaların % 5'i kronik hastadır ve bu kronik hastaların, yaklaşık dörtte birinde siroza ve hepatosellüler karsinoma ilerleme olmakta ve bu hastalardan da yaklaşık yılda 1milyon kişi hepatit B virüsüne bağlı komplikasyonlar nedeniyle kaybedilmektedir Kronik hepatit B (KHB) tedavisinde kullanılan entekavir (ETV) ve tenofovir (TNF), genetik bariyerleri yüksek güçlü antiviral ilaçlardır. Literatürde KHB tedavisinde ETV ve TNF kullanımına ait karşılaştırmalı çalışmaların bir yıldan sonraki sonuçları bulunmadığı için, polikliniğimizde takip edilen ETV veya TNF kullanan hastaların karşılaştırmalı olarak uzun dönem sonuçları değerlendirilmek istenmiştir. Çalışmaya, naive, en az 6 ay KHB tedavisi için ETV veya TNF kullanmış olan, ETV grubunda 140, TNF grubunda 49 hasta alındı. Hastaların başlangıç ve tedavinin 3 ile 6. ay ve sonrasında 6 ayda bir ALT, kreatinin, HBsAg, HBVDNA, HBeAg, Anti HBe durumları, ilaca bağlı yan etkiler ile ilaç değişimleri değerlendirilmiştir. Her iki grup arasında, yaş, sirozlu hasta, HbeAg (+) hasta, başlangıç HBV DNA ve ALT oranları, başlangıç HAİ ve fibroz değerleri ve ortalama izlem süreleri arasında istatistiki fark saptanmamıştır. ETV ve TNF sonuçları karşılaştırıldığında, ALT normalleşmesi 3.yıla kadar , HBV DNA negatifleşmesi 18 ve 24. aylarda, entekavir grubunda tenofovir grubuna göre daha fazla oranda idi. Ancak ALT normalleşmesi 3. yıldan itibaren, HBV DNA negatifleşmesi 2. yıldan itibaren her iki grupta benzer özelliklere sahipti. Her iki grupta da kreatinin-fosfor seyri, HBeAg kaybı, yan etki ile karşılaşma ve ilaç değişim oranları benzerdi. Siroz hastalarında, MELD skorlarında birinci yılda, Child skorlarında ise 1. ve 2. yılda düzelme görülürken izleyen yıllarda iyileşme görülmemiştir

The Relationship Between Factor VIII and Coronary Artery Diseases

Aim: Cardiovascular diseases are the major cause of morbidity and mortality worldwide. There are some evidences showing a possible role for hemotostatic system in the pathogenesis of atherosclerotic vascular diseases. In our study, we aimed to show the relationship between coronary artery diseases and factor VIII (F VIII). Methods: 60 patients were included in the study. Blood samples for F VIII were taken before and after the standard Bruce treadmill stress test. Patients with positive stress test underwent coronary angiography. Results: The F VIII levels after the treadmill test were statistically significantly high (p:0.0001) compared to that before the test. A significant difference was determined in favor of female patients both before (p=0.002) and after (p=0.009) the treadmill exercise test when F VIII levels were assessed by gender. Conclusion: Since the discovery of the important role of thrombosis in the pathogenesis of atherosclerotic diseases, investigators are working on whether the haemostatic status is the primary risk factor in coronary artery disease (CAD).Our study results, similar to the literature, showed that F VIII levels in women can be helpful in the diagnosis and follow-up of CAD. But as shown in other studies, F VIII levels may increase in an inflammatory state. Therefore, further studies are needed to determine whether CAD is caused by high levels of F VIII or risk factors for CAD cause endothelial damage and, thus, high levels of F VIII are the result of an inflammatory process. (The Me di cal Bul le tin of Ha se ki 2012; 50: 113-8

Diurnal changes of critical flicker frequency in patients with liver cirrhosis and their relationship with sleep disturbances

WOS: 000345234100012PubMed ID: 25192605Background: We aimed to measure the diurnal changes of critical flicker frequency in healthy subjects and cirrhotic patients and to investigate their relationship with sleep disturbance. Methods: Cirrhotic patients and healthy volunteers were included. All groups completed the Pittsburgh Sleep Quality Index and a simple sleep questionnaire. Sleep disturbance was defined as a Pittsburgh Sleep Quality Index score of >5. Critical flicker frequency was measured twice a day to detect diurnal abnormalities. Results: Overall, 59 cirrhotic patients (54.2% males, Mean Age 59 +/- 11 years) and 18 controls (39.9% males, Mean Age 58 +/- 9 years) were included. Sleep disturbances were more common in cirrhotics (66.1%) than controls (38.9%, p < 0.05). In cirrhotics, the critical flicker frequency was not related to decompensation. The nocturnal values were higher than the morning values in cirrhotics (64.4%), but not in controls (p < 0.0001). Additionally, sleep disturbances were more common in cirrhotics who had higher nocturnal values (p < 0.05). Conclusions: Changes in the diurnal critical flicker frequency were observed in cirrhotics but not in controls. Sleep disturbances in cirrhotics appear to be associated with deviations of the diurnal rhythm of critical flicker frequency rather than with clinical parameters such as the clinical stages of cirrhosis and the Model For End-Stage Liver Disease and Child-Pugh scores. (C) 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved

A single-center experience: Liver biopsy results during a year

Background and Aim: Liver biopsy is the gold standard method for the diagnosis and treatment of liver diseases. In this study, we aimed to evaluate the results of liver biopsies performed in a year in our clinic. In addition, we also aimed if these liver biopsies could reveal the etiology of liver disease in patients with elevations of transaminases or/and alkaline phosphatase levels or liver masses. Materials and Methods: Patients who had liver biopsies for persistently elevated transaminases or/and alkaline phosphatase levels, protocol biopsies after liver transplantation, or liver masses in our hepatology clinic between 2011 and 2012 were included in the study. Liver biopsy decisions were made by experts during the hepatology council. Liver biopsies were previously performed using classical percutaneous liver biopsy or ultrasonography-guided Sonocan (R) liver biopsy sets. The pathology results of liver biopsies and clinical data of the matching patients were obtained from the liver biopsy record archives and patient files, respectively. Results: Totally, 479 liver biopsy results (male=252, 52.6%, mean age 49 +/- 14.5 years) were evaluated in the study. Of these patients, 432 (male=228) underwent percutaneous liver biopsy and 47 (male=24) underwent Sonocan (R) needle biopsy. The most common histopathologic diagnoses in the percutaneous liver biopsy group were chronic hepatitis B (n=127, 29.4%), normal histopathological findings (n=50, 11.6% and 32 of them were protocol biopsies after liver transplantation), and nonalcoholic steatohepatitis (NASH, n=41, 9.5%). The most common histopathologic diagnoses in the Sonocan (R) group were 25 liver metastasis out of 29 liver tumors (n=25, 53.2% of all) chronic hepatitis B (n=5, 10.6%), and NASH (n=3, 6.4%). Conclusion: In this study, diversity in liver biopsy results indicates the importance of histopathological evaluation. The most prevalent pathology in the liver biopsies was chronic hepatitis B, which is the most common chronic liver disease in Turkey. The metastatic liver tumor was the most common among the liver masses

Circadian changes in Critical Flicker Frequency in Cirrhotics and its relation with Sleep Disturbances

63rd Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD) -- NOV 09-13, 2012 -- Boston, MAWOS: 000310955603147Amer Assoc Study Liver Di

Relationship Between Left Ventricule Hypertrophy and inflammation and Albuminuria in Patients with Type 2 Diabetes Mellitus

The strong association between diabetes mellitus and the cardiac left ventricular hypertrophy can be partially explanatory for the cardiovascular complications and end organ damage in diabetes, In our study we planned to compare the levels of inflammatory markers and albuminuria, the index for renal failure, between type 2 diabetic patients with and without LVH, with the purpose to find out if the following up of the inflammatory markers in Type 2 diabetic patients can be important for the prevention of the development of cardiac and renal complications