Real life data of second generation direct acting oral antivirals in the treatment of chronic hepatitis C: a single center and heterogeneous patient group

Kronik hepatit C enfeksiyonu karaciğer sirozu ve hepatoselüler karsinomun nedenleri arasındadır. Bu çalışmada primer olarakkronik hepatit C’li heterojen bir hasta grubunda güncel olarak kullanılanikinci kuşak direk etkili oral antivirallerin tedavi etkinliği ve yan etki profillerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Retrospektifolan bu çalışmaya ikinci kuşak direk etkili oral antiviral tedavi alan 72hasta dahil edilmiştir. Hastalara ait klinik ve laboratuvar verileri polikliniktakip dosyalarından elde edilmiştir. Bulgular: Hastaların yaş ortalaması 58±14 olup, 39’u (%54) kadın idi. Baskın genotip 1b idi (%74.6).Non-sirotik, kompanse siroz ve dekompanse siroz hastaların sayıları sırasıyla; 56 (%77.8), 14 (%19.4) ve 2 (%2.8) idi. On sekiz hasta (%25)tedavi deneyimli idi. Paritaprevir/ritonavir/ombitasvir + dasabuvir, ledipasvir/sofosbuvir, ledipasvir/sofosbuvir + ribavirin, sofosbuvir + ribavirin, glekaprevir + pibrentasvir ve paritaprevir/ritonavir/ombitasvir +ribavirin alan hasta sayıları sırasıyla; 38 (%52.8), 13 (%18.1), 7 (%9.7),7 (%9.7), 6 (%8.3) ve 1 (%1.4) idi. Toplam 71 hasta tedaviyi tamamladıve bunların 69’unda (%97.2) kalıcı viral yanıt elde edildi. Ayrıca başlangıç aspartat aminotransferaz, alanin amimotransferaz, gama glutamiltransferaz ve alfa fetoprotein düzeylerinde tedavi ile birlikte anlamlı birdüşüş izlendi (p <0.05). Bilirübin düzeyleri ise tedavi esnasında anlamlıbir şekilde yükselmekle beraber (p <0.05), tedavinin sona ermesiyle birlikte düşüş göstermekteydi. Yan etki profilleri açısından, kullanılan tümrejimlerde gözlenen yan etkiler hafif şiddette olup, tedaviyi kesecek vasıfta değildi. Sonuç: Ülkemizde kronik hepatit C infeksiyonunda güncelolarak kullanılan ikinci kuşak direk etkili oral antiviraller yüksek etkinlikve düşük yan etki profiline sahiptirler.Chronic hepatitis C infection is one of the causes of liver cirrhosis and hepatocellular carcinoma. The purpose of this study was primarily to examine the treatment efficacy and side effect profiles of second-generation direct-acting oral antivirals currently used in a heterogeneous patient group with chronic hepatitis C. Materials and Methods: This retrospective study included 72 patients who received second-generation direct-acting oral antiviral therapy. Clinical and laboratory data of the patients were collected from outpatient follow-up files. Results: The mean age of the patients was 58±14 years, of which 39 (54%) were women. The predominant genotype was 1b (74.6%). Patients with no cirrhosis, compensated cirrhosis, and decompensated cirrhosis were 56 (77.8%), 14 (19.4%), and 2 (2.8%), respectively. Eighteen patients (25%) were treatment experienced. On the other hand, patients treated with paritaprevir/ritonavir/ombitasvir + dasabuvir, ledipasvir/sofosbuvir, ledipasvir/sofosbuvir + ribavirin, sofosbuvir + ribavirin, glecaprevir + pibrentasvir, and paritaprevir/ritonavir/ombitasvir + ribavirin were 38 (52.8%), 13 (18.1%), 7 (9.7%), 7 (9.7%), 6 (8.3%), and 1 (1.4%), respectively. A total of 71 patients completed the treatment and 69 of them (97.2%) was obtained sustained viral response. In addition, a significant decrease was observed in the initial aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase, and alpha fetoprotein levels during treatment (p <0.05). Although bilirubin levels increased significantly during treatment (p <0.05), they decreased at the end of treatment. In terms of the side effect profile, side effects observed in all regimes were mild and not severe enough to discontinue treatment. Conclusion: Therefore, the second-generation direct-acting oral antivirals widely used in chronic hepatitis C infection in our country have high efficacy and low side effect profile

Parkinson hastalarında perkütan endoskopik gastrojejunostomi katateri takılan hastalarımızın takibi: Tek merkez deneyimi

Giriş Ve Amaç: Perkütan endoskopik gastrostomi ve perkütan endoskopik gastrojejunostomi enteral nutrisyonda sık kullanılan yöntemlerdir. Son yıllarda ileri evre Parkinson Hastalığı tedavisinde, Levodopa/Karbidopa intestinal jel, perkütan endoskopik gastrojejunostomi ile uygulanmaktadır. Biz, burada Parkinson Hastalığı tedavisi için pull tekniği ile perkütan endoskopik gastrojejunostomi katateri yerleştirilen hastalarımızın takiplerini sunmayı amaçladık. Gereç ve Yöntem: Mayıs 2019 - Mart 2022 yılları arasında perkütan endoskopik gastrojejunostomi takılan 11 hasta incelendi, hastalara ait demografik veriler, işlem sonrası komplikasyonları ve işlem tekrarları değerlendirildi. Bulgular: Perkütan endoskopik gastrojejunostomi takılan hastaların 1’i (%9) kadın, 10’u erkek (%91), yaş ortalaması 63.5 ± 11.2 olup en genç hasta 43 ve en yaşlı hasta 78 yaşındaydı. Onbir hastaya perkütan endoskopik gastrojejunostomi takılması, perkütan endoskopik gastrostomi ve jejunal tüp değişimi olmak üzere toplam 23 endoskopik işlem uygulandı. İlk perkütan endoskopik gastrojejunostomi takılması sonrasında perkütan endoskopik gastrojejunostomi seti ve/veya sadece jejunal katater replasmanı arasındaki ortalama süre 310.5 ± 252.3 gün iken en kısa süre 60 gün, en uzun süre 674 gündü. Replasmanlar arasındaki en kısa süre 26 gün iken, en uzun süre 641 gündü. Hiçbir hastada akut ya da majör komplikasyon görülmezken, jejunal katater tıkanması (3’ü ilaç ile, 1’i king olması) %28.5 oranında en fazla görülen minör komplikasyon olmuştur. Bunu sırasıyla %21.4 (3 olgu) stoma enfeksiyonu, %14.2 (2 hasta) perkütan endoskopik gastrostomi aşınması, %14.2 (2 hasta) jejunal tüpün yanlışlıkla çekilmesi, %7.1 perkütan endoskopik gastrostomi tıkanması (n=1) ve %7.1 (n=1) perkütan endoskopik gastrojejunostomi setinin çekilmesi izlemiştir. Ondört adet toplam advers olay bildirilmiştir. Sonuç: Perkütan endoskopik gastrojejunostomi yerleştirme ve değiştirmesi güvenli bir prosedürdür, ancak perkütan endoskopik gastrojejunostominin uzun süreli kullanımını ve dayanıklılığını araştıran çok az veri bulunmaktadır, replasman için en iyi zamanı ve uzun süreli klinik sonuçları gösteren prospektif çalışmalara ihtiyaç vardır

Effect of Direct-acting Oral Anticoagulants and Warfarin on Hospital Outcomes in Upper Gastrointestinal Bleeding

Objective: To evaluate the comparison of direct-acting oral anticoagulants (DOACs) and warfarin for their effects on major bleeding and hospital outcomes in patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). Study Design: An observational study. Place and Duration of Study: Tekirdag Namik Kemal University Hospital, Hitit University Erol Olçok Education and Research Hospital, between January and December 2021. Methodology: Adult patients prescribed warfarin and DOACs were followed up for one year. Their length of hospital stay, need for intensive care unit admission, need for red blood cell transfusion, and major bleeding rates were compared. Results: Thirty-two patients (61.5%) were user of DOACs (DOAC group), and 20 patients (38.5%) were users of warfarin (warfarin group). No statistically significant difference was determined between patients in warfarin group and DOAC group for the number of packed red blood cells transfused [median 3 (0-6) units, 3 (0-10) units, p=0.229, respectively], length of hospital stay [median 5 days (3-10), and 4.5 days (2-20), p=0.739, respectively], rate of intensive care unit admission [(n=9, 45%; and n=10 (31%), p=0.623, respectively] and the occurrence of major bleeding events (warfarin-70%; DOACs-78%; p=0.529). Conclusion: Major bleeding episodes and hospital outcomes of acute NVUGIB were similar between patients receiving warfarin and DOACs. © 2022 College of Physicians and Surgeons Pakistan. All rights reserved

Clinical relevance of virulence genes in Helicobacter pylori isolates recovered from adult dyspeptic patients in Turkey

Purpose: Bacterial virulence factors play a major role in the pathogenesis of Helicobacter pylori infection. The aims of this study were to evaluate virulence genes in H. pylori isolates and to compare the presence of these genes and associated clinical pathologies. Methods: A total of 148 H. pylori isolates, recovered from adult dyspeptic patients, were used. The patients, from whom the isolates were obtained, were assigned to two groups by their endoscopic findings, which manifested as chronic gastritis or peptic ulcer. The presence of gastric atrophy and intestinal metaplasia was recorded for each patient, based on histopathological examination. Analyses of the virulence genes were performed by the polymerase chain reaction technique. Results: The patients had a mean age of 47 ?± ?15 years and 86 (58%) of them were female. Based on endoscopic examination, 103 (69.6%) patients were diagnosed with chronic gastritis and 45 (30.4%) with peptic ulcer. Histopathological examination revealed intestinal metaplasia in 30 (20%) patients and gastric atrophy in 12 (8%) patients. The prevalence rates of cagA, cagE, iceA1, iceA2, and babA2 were determined to be 87%, 74%, 58%, 26%, and 95%, respectively. The most prevalent vacA alleles were s1/s1a (82%/97%) and the least prevalent allele was s2 (20%). A new vacA genotype (s1as1bs1c) was detected, for the first time, in 18 (12%) isolates. No significant difference was found between the patient groups with chronic gastritis and peptic ulcer for the prevalences of the virulence genes (p ?> ?0.05). Furthermore, intestinal metaplasia and gastric atrophy showed no significant correlation with the virulence genes (p ?> ?0.05). Conclusions: It is thoughted that H. pylori isolates with predominant cagA, cagE, VacA (s1, s1a), and babA2 virulence genes are associated with gastroduodenal diseases. However, there is no correlation between gastric premalignant lesions and virulence genes. © 2022 Indian Association of Medical Microbiologist

The predictive value of neutrophil-lymphocyte ratio and mean platelet volume in patients with colorectal carcinoma

Aim: This study aimed to investigate neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) for predicting colorectalcancer (CRC).Material and Methods: We investigated retrospectively patients who underwent colonoscopy. The study consisted of 75 patientswith CRC and 91 study participants with normal colonoscopy as control group, and MPV and NLR were compared between groups.MPV and NLR were also investigated for tumor stage and metastasis.Results: Among the CRC patients the mean NLR value (3.09 vs 2.26) and PLT count (287080 vs 251857) were significantly higher,whereas the mean MPV (9.62 vs 10.68 fL) and hemoglobin level (11.62 vs 14.18 g/dl) were significantly lower in the CRC group. WBCcount was not significantly different between the groups. Mean NLR in metastatic patients and non-metastatic patients were 3.56and 2.73, respectively (p:0.01).Conclusion: We showed that high NLR and low MPV are associated with CRC. Elevated NLR is related with presence of CRC and itcan be used for risk prediction. Although we found lower MPV levels, conflicting results about MPV in CRC prevents it from using asa marker in CRC

Kronik hepatit C tedavisinde ikinci kuşak direk etkili oral antivirallerin gerçek yaşam verileri: Tek merkez ve heterojen hasta grubu

Kronik hepatit C enfeksiyonu karaciğer sirozu ve hepatoselüler karsinomun nedenleri arasındadır. Bu çalışmada primer olarakkronik hepatit C’li heterojen bir hasta grubunda güncel olarak kullanılanikinci kuşak direk etkili oral antivirallerin tedavi etkinliği ve yan etki profillerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Retrospektifolan bu çalışmaya ikinci kuşak direk etkili oral antiviral tedavi alan 72hasta dahil edilmiştir. Hastalara ait klinik ve laboratuvar verileri polikliniktakip dosyalarından elde edilmiştir. Bulgular: Hastaların yaş ortalaması 58±14 olup, 39’u (%54) kadın idi. Baskın genotip 1b idi (%74.6).Non-sirotik, kompanse siroz ve dekompanse siroz hastaların sayıları sırasıyla; 56 (%77.8), 14 (%19.4) ve 2 (%2.8) idi. On sekiz hasta (%25)tedavi deneyimli idi. Paritaprevir/ritonavir/ombitasvir + dasabuvir, ledipasvir/sofosbuvir, ledipasvir/sofosbuvir + ribavirin, sofosbuvir + ribavirin, glekaprevir + pibrentasvir ve paritaprevir/ritonavir/ombitasvir +ribavirin alan hasta sayıları sırasıyla; 38 (%52.8), 13 (%18.1), 7 (%9.7),7 (%9.7), 6 (%8.3) ve 1 (%1.4) idi. Toplam 71 hasta tedaviyi tamamladıve bunların 69’unda (%97.2) kalıcı viral yanıt elde edildi. Ayrıca başlangıç aspartat aminotransferaz, alanin amimotransferaz, gama glutamiltransferaz ve alfa fetoprotein düzeylerinde tedavi ile birlikte anlamlı birdüşüş izlendi (p <0.05). Bilirübin düzeyleri ise tedavi esnasında anlamlıbir şekilde yükselmekle beraber (p <0.05), tedavinin sona ermesiyle birlikte düşüş göstermekteydi. Yan etki profilleri açısından, kullanılan tümrejimlerde gözlenen yan etkiler hafif şiddette olup, tedaviyi kesecek vasıfta değildi. Sonuç: Ülkemizde kronik hepatit C infeksiyonunda güncelolarak kullanılan ikinci kuşak direk etkili oral antiviraller yüksek etkinlikve düşük yan etki profiline sahiptirler.Chronic hepatitis C infection is one of the causes of liver cirrhosis and hepatocellular carcinoma. The purpose of this study was primarily to examine the treatment efficacy and side effect profiles of second-generation direct-acting oral antivirals currently used in a heterogeneous patient group with chronic hepatitis C. Materials and Methods: This retrospective study included 72 patients who received second-generation direct-acting oral antiviral therapy. Clinical and laboratory data of the patients were collected from outpatient follow-up files. Results: The mean age of the patients was 58±14 years, of which 39 (54%) were women. The predominant genotype was 1b (74.6%). Patients with no cirrhosis, compensated cirrhosis, and decompensated cirrhosis were 56 (77.8%), 14 (19.4%), and 2 (2.8%), respectively. Eighteen patients (25%) were treatment experienced. On the other hand, patients treated with paritaprevir/ritonavir/ombitasvir + dasabuvir, ledipasvir/sofosbuvir, ledipasvir/sofosbuvir + ribavirin, sofosbuvir + ribavirin, glecaprevir + pibrentasvir, and paritaprevir/ritonavir/ombitasvir + ribavirin were 38 (52.8%), 13 (18.1%), 7 (9.7%), 7 (9.7%), 6 (8.3%), and 1 (1.4%), respectively. A total of 71 patients completed the treatment and 69 of them (97.2%) was obtained sustained viral response. In addition, a significant decrease was observed in the initial aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase, and alpha fetoprotein levels during treatment (p <0.05). Although bilirubin levels increased significantly during treatment (p <0.05), they decreased at the end of treatment. In terms of the side effect profile, side effects observed in all regimes were mild and not severe enough to discontinue treatment. Conclusion: Therefore, the second-generation direct-acting oral antivirals widely used in chronic hepatitis C infection in our country have high efficacy and low side effect profile

Autoimmune hepatitis as an overlap of secondary antiphospholipid syndrome

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