The relationship between clinical activity and mean platelet volume (MPV) in inflammatory bowel di̇seases

İnflamatuvar barsak hastalıkları (İBH), gastrointestinal sistemin ağızdan anüse kadar çeşitli bölge ve katmanlarını tutabilen, alevlenme-remisyonlarla seyreden, genetik yatkınlık gösteren ve ekstraintestinal belirtiler gösterebilen kronik seyirli hastalıklardır.İBH'nın hastalık aktivasyonunu göstermek içinpek çok aktivite indeksleri kullanılmasına rağmen hastalığın aktivasyonunun belirlenmesinde henüz fikir birliği sağlanamamıştır.Bu çalışmanın amacı İBH'da ucuz ve ek bir masraf gerektirmeyen mean platelet volüme'nin (MPV) klinik aktivasyonu göstermede bir markır olarak kullanılabilirliğini araştırmaktır. Yöntem:N.E.Ü. Meram Tıp Fakültesi Gastroenteroloji Servisi ve Poliklinikleri ile İç Hastalıkları Polikliniklerinde Ocak 2010-Aralık 2015 tarihleri arasında takip edilmiş olan 18 yaş üzeri, kolonoskopik ve histopatolojik olarak tanısı doğrulanan, klinik olarak aktif 94 Ülseratif Kolit, 45 Crohn hastası ve sağlıklı 140 kişi çalışmaya dâhil edilmiştir. Hastaların poliklinik ve servis dosyaları geriye dönük olarak taranmıştır. Anamnez bilgileriyle birlikte, laboratuar sonuçları, kolonoskopik ve patoloji raporları kayıt altına alınmıştır. Ülseratif kolit aktivasyonu için Rachmilewitz Klinik Aktivite ve Endoskopik İndeksleri, Crohn Hastalığı aktivasyonu için Crohn's Disease Activity Index(CDAI) kullanılmışır. Bulgular: Ortalama trombosit hacmi(MPV), inflamatuvar barsak hastalarında kontrol grubuna oranla daha düşük bulundu (p18 years of age and clinically active withconfirmeddiagnosisbycolonoscopy and histopathology and 140 healthy control wereincluded in thisstudy in N.E.U. Meram MedicalFaculty, Department of Gastroenterology and InternalMedicinebetweenJanuary 2010- December 2015. File records of the patientswerereviewedretrospectively. Medicalhistory, laboratory, colonoscopy and pathologyreportswererecorded. Rachmilewitz Clinical Activity and EndoscopicActivation Index wereused for Ulcerative Colitis. Crohn's Disease Activity Index (CDAI) was used for activation of Crohn's Disease. Results: Mean platelet volume (MPV), was significantly lower in the inflammatory bowel group than control group (p<0.05). Furthermore, in active disease group MPV value was significantly lower than remission group (p<0.05). Conclusion: In inflammatory bowel disease, inflammatory parameters can be used for diagnosis and disease activity. MPV can be used as an inflammatory marker for determination of inflammatory bowel disease activity. Keywords: Ulcerative colitis, Crohn's Disease, MPV, Inflammatory Bowel Diseas

Serum soluble TWEAK levels in non-alcoholic fatty liver disease

Aim: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The exact pathogenesis of NAFLD hasnot been fully elucidated. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a member of TNF superfamily and it hasbeen implicated in the pathogenesis of several diseases including liver inflammation and fibrosis. Current study was conducted toevaluate serum sTWEAK levels in patients with NAFLD.Material and Methods: Seventeen patients with biopsy proven non-alcoholic steatohepatitis (NASH), 22 patients with simplehepatosteatosis and 30 healthy controls were included in the study and serum sTWEAK concentrations were measured usingcommercial ELISA kits.Results: Mean serum sTWEAK concentration was significantly lower in the NASH group when compared to the simple hepatosteatosisgroup and healthy controls (199.6101.2 pg/mL, 246.165.7 pg/mL and 277.6117.6 pg/mL respectively, p0.029). ROC analysesfor sTWEAK to differentiate NASH patients from healthy controls and from simple hepatosteatosis revealed that AUC for sTWEAKwas 0.712 (%95 CI, 0.543-0.880). For the specified cut off value, 171.1 pg/mL positive and negative predictive values calculated were64.3% and 85.5% respectively.Conclusion: Serum sTWEAK concentration is decreasedin patients with NASH when compared to patients with simple hepatosteatosisand healthy controls

Kronik Hepatit C’de Üçlü Tedavi: Bir Üniversite Hastanesi Gastroenteroloji Kliniğinin Deneyimi

Amaç: Pegile interferonribavirin kombinasyonu uzun yıllar kronik hepatit C tedavisinde standart tedavi olmuştur. Son yıllarda proteaz inhibitörleri bu kombinasyona ilave edilmiş ve daha yüksek kalıcı virolojik yanıt oranları elde edilebilmiştir. Biz bu çalışmada kliniğimizde takip edilen ve PEG-İFNribavirinproteaz inhibitörü içeren üçlü tedavi alan hastalarımızın verilerini retrospektif olarak değerlendirmeyi amaçladık.Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji Kliniğine Aralık 2012-Aralık 2015 tarihleri arasında başvuran ve proteaz inhibitörü içeren 3'lü tedavi verilen 23 kronik HCV hastasının verileri retrospektif olarak incelenmiştir.Bulgular: Hastaların 18'i (%78,3) kadın ve 5'i (%21,7) erkek ve median yaşları 58 yıl (Aralık 42-70 yıl) idi. Toplam 16 hastada (%69,6) kalıcı virolojik yanıt elde edilmişti. Telaprevir kullanan 18 hastanın 13'ünde (%72,2) ve boseprevir kullanan 5 hastanın 3'ünde (%60) kalıcı virolojik yanıt elde edildi. Daha önce PEG IFNribavirin ikili tedavisi alıp nüks olan 11 hastanın 10'unda (%90,1), kısmi yanıt veren 3 hastanın tamamında ve ilk tedavide primer yanıtsız olan 4 hastanın 2'sinde (%50) kalıcı virolojik yanıt elde edildi. Sirotik olan 9 hastanın 7'si (%77,8) planlanan tedavi süresini tamamladı, 5 hastada (%55,6) kalıcı virolojik yanıt elde edildi. Sirozu olmayan 14 hastanın 12'si (%85,7) tedaviyi tamamlarken, bu hastaların 11'inde (%78,5) kalıcı virolojik yanıt elde edildi. 4 hastada (%17,4) çeşitli yan etkiler nedeniyle tedavi süresi tamamlanamadı.Sonuç: İnterferonsuz tedavi rejimlerinin ülkemizde henüz rutin kullanıma girmediği göz önüne alınırsa, seçilmiş vakalarda PEG IFN, ribavirin ve bir proteaz inhibitörü içeren üçlü tedavilerin hala bir seçenek olabileceği kanaatindeyiz.Objective: Pegylated interferonribavirin dual combination had been the standard treatment for chronic hepatitis C for years.Recently protease inhibitors were added to this combination.In this manuscript, we aimed to review the data of the patients to whom Pegylated interferonribavirinprotease inhibitor containing triple therapy regimen were given in our clinic.Material and Method: This was a retrospective study and 23 chronic hepatitis C patients treated with triple therapy regimen in Necmettin Erbakan University, Meram Faculty of Medicine, Department of Gastroenterology, between December 2012 and December 2015 were included.Results: There were 18 (78.3%) male and 5 (21.7%) female patients and median age was 58 years (range 42-70 years). 16 (69.6%) patients achieved sustained virological response. Thirteen (72.2%) of 18 patients on telaprevir regimen and 3 (60%) of 5 patients on boceprevir regimen achieved sustained virological response.When virological response in the prior pegylated interferonribavirin treatment was taken into consideration;10 (90.1%) of 11 patients with relapse,3 patients (100%) with partial response and 2 (50%) of 4 non-responders were found to achieve sustained virological response. Seven (77.8%) of 9 cirrhotic patients completed the planned treatment and sustained virological response was achieved in 5 (55.6) patients. 12 (85.7%) of 14 non-cirrhotic patients completed the planned treatment and sustained virological response was achieved in 11 (78.5%) patients.Treatment was discontinued in 4 (17.4%) patients due to various side effects.Conclusion: Taking into consideration that novel interferon free treatment regimens are not available in our country yet, triple combination with Pegylated interferonribavirin and protease inhibitor is still a treatment option for chronic hepatitis C in selected cases

Changing Trends in the Etiology of Cirrhosis in Türkiye: A Multicenter Nationwide Study

Background/Aims: The aim of our study was to investigate the underlying causes behind the etiology of cirrhosis in Türkiye. Materials and Methods: The study was comprised of patients with cirrhosis located in the gastroenterology clinics of 28 centers in Türkiye between January 2000 and June 2021. Results: The study group consisted of 4953 cirrhotic patients (median age: 62.2 years, male / female: 58% / 42%). Among the patients, 39% of the patients were compensated, and 61% were decompensated. Furthermore, 47.5% had Child-Pugh class A, 38% had Child-Pugh class B, and 14.5% had Child-Pugh class C. The most frequent complaints were abdominal bloating (28%). Ascites (54.2%) was the most common manifestation of decompensation. The median Child-Pugh and MELD-Na scores were 7.0 and 10.0, respectively. The most common cause of cirrhosis was chronic viral hepatitis (43%), followed by cryptogenic cirrhosis (CC) (19%), metabolic dysfunction-associated steatotic liver disease (MASLD)-related cirrhosis (13%), and alcohol-related cirrhosis (11%). Among the 950 patients with CC, 416 had metabolic abnormalities. If these 416 CC patients with metabolic abnormalities were categorized as having MASLD-related cirrhosis, the proportion of MASLD-related cirrhosis increased to 21%. Thirteen percent of the patients were diagnosed with HCC, while 4% had extrahepatic malignancy. Female breast cancer (18%) and colorectal cancer (18%) were the most frequent extrahepatic malignancies