Evaluation of the ability of insulin resistance and lipid-related indices to predict the presence of NAFLD in obese adolescents.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has become an important health issue in adolescents. Although several parameters and indices have been investigated for the evaluation of NAFLD in adults, these indices are limited in adolescents. In this study, body mass index, waist circumference, triponderal mass index, HbA1c, homeostatic model assessment insulin resistance (HOMA-IR), triglyceride/high-density lipoprotein (Tg/HDL), the lipid accumulation product (LAP) index, the triglyceride-glucose (TyG) index and the aminotransferase (AT) index were examined together, and their diagnostic values in the clinical treatment of NAFLD were compared. MATERIALS AND METHODS: Seventynine adolescents (10-19 years old) with obesity who were admitted to a pediatric clinic between January and August 2022 and who were diagnosed with exogenous obesity without any comorbidities were included in the study. The presence of NAFLD was evaluated by liver magnetic resonance imaging. The laboratory findings were obtained retrospectively from system records. Parameters were compared between the NAFLD (+) and NAFLD (-) groups. Logistic regression analysis was used to determine the most effective factors for NAFLD treatment. Receiver operating characteristic (ROC) analysis was performed with significant indices. Sex, HOMA-IR, TyG and AT indices were evaluated together with multivariate analysis to design a diagnostic scale. RESULTS: HbA1c, HOMA-IR, AT indices and TyG indices were greater in the NAFLD (+) group (P = 0.012; P = 0.001; P = 0.012; P = 0.002, respectively). There was a positive correlation between liver fat percentage and HOMA-IR, the TyG index, the AT index, and Tg/HDL. According to the regression analysis, male sex and elevated HOMA-IR were determined to be significant risk factors for the presence of NAFLD. A probability scale with 4 parameters [sex, HOMA-IR, the TyG index, and alanine aminotransferase (ALT)] was designed with 82.5% specificity and 80% sensitivity. CONCLUSION: Evaluation of the HOMA-IR and TyG indices, especially in high-risk patients, will support the diagnosis of NAFLD via ultrasonography. A probability scale with ALT, HOMA-IR, TyG, and sex data with a diagnostic accuracy of 80% may aid in the diagnosis of NAFLD in adolescents with obesity.

Low recurrence rate of hepatocellular carcinoma following ledipasvir and sofosbuvir treatment in a real-world chronic hepatitis C patients cohort.

The aims of the present study were to evaluate the efficacy and tolerability of ledipasvir/sofosbuvir (LDV/SOF) with or without ribavirin in the treatment of chronic hepatitis C (CHC) in patients with advanced liver disease and to analyse whether the use of LDV/SOF treatment is associated with a new occurrence of hepatocellular carcinoma (HCC) during and after LDV/SOF treatment. The Turkish Early Access Program provided LDV/SOF treatment to a total of 200 eligible CHC patients with advanced liver disease. The median follow-up period was 22 months. All patients were Caucasian, 84% were infected with genotype 1b, and 24% had a liver transplantation before treatment. The sustained virological response (SVR12) was 86.0% with ITT analysis. SVR12 was similar among patients with Child-Pugh classes A, B and C disease and transplant recipients. From baseline to SVR12, serum ALT level and MELD score were significantly improved (P < 0.001). LDV/SOF treatment was generally well tolerated. Only one patient developed a new diagnosed HCC. Seventeen of the 35 patients, who had a history of previous HCC, developed HCC recurrence during the LDV/SOF treatment or by a median follow-up of 6 months after treatment. HCC recurrence was less commonly observed in patients who received curative treatment for HCC compared with those patients who received noncurative treatment (P = 0.007). In conclusion, LDV/SOF with or without ribavirin is an effective and tolerable treatment in CHC patients with advanced liver disease. Eradication is associated with improvements in liver function and a reduced risk of developing a new occurrence of HCC.

Daclatasvir plus asunaprevir dual therapy for chronic HCV genotype 1b infection: results of Turkish early access program.

 Background. Daclatasvir and asunaprevir dual therapy is approved for the treatment of HCV genotype 1b infection in several countries. AIM: To evaluate the efficacy and safety of daclatasvir and asunaprevir dual therapy in Turkish patients. MATERIAL AND METHODS: Sixty-one patients with HCV genotype 1b were enrolled in the Turkish early access program. Most of the patients were in difficult-to-treat category. Patients were visited at each 4 week throughout the follow-up period. Laboratory findings and adverse events were recorded at each visit. RESULTS: Fifty-seven of 61 enrolled patients completed 24 weeks of treatment. Two patients died as a result of underlying diseases at 12-14th weeks of treatment. Two patients stopped the treatment early as a consequence of virological breakthrough, and 2 patients had viral relapse at the post-treatment follow-up. Overall SVR12 rates were 90% (55/61) and 93.2% (55/59) according to intention-to-treat (ITT) and per protocol (PP) analysis respectively. In ITT analysis, SVR12 was achieved by 93% (13/14) in relapsers, 80% (12/15) in interferon-ineligible patients and 91% (20/22) in previous nonresponder patients. SVR12 rates were 86.5% and 91.4% in patients with cirrhosis according to ITT and PP analysis respectively. SVR12 was 95.8% in non-cirrhosis group in both analysis. Patients with previous protease inhibitor experience had an SVR12 of 87.5%. Common adverse events developed in 28.8% of patients. There were no treatment related severe adverse event or grade-4 laboratory abnormality. CONCLUSIONS: Daclatasvir and asunaprevir dual therapy is found to be effective and safe in difficult-to-treat Turkish patients with HCV genotype 1b infection.

Correlation between the tissue ghrelin presence, disease activity and laboratory parameters in ulcerative colitis patients; immunohistochemical study.

BACKGROUND: The aim of the study was to determine the differences in terms of ghrelin presence in the colon between the patients with ulcerative colitis (UC) and control patients. METHODS: Sixty-one UC and 15 control patients were included in the study. Immunohistochemical staining for ghrelin was investigated in colonic biopsy samples of UC and control patients. UC patients were subdivided into Group A (absence of ghrelin staining) and Group B (presence of staining for ghrelin in biopsy samples). Disease activity scores, laboratory parameters and quantitative ghrelin staining were compared in both groups of UC patients, as well as with the observations in control patients. RESULTS: Cells in colonic mucosa stained for ghrelin were identified in twenty-three (37.7%) UC patients, while this proportion in control patients was 6/15(40%). A significant difference was found between Groups A and B for serum albumin concentration but not for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin concentration or leucocyte count. Mayo score/disease activity index (DAI) for UC were significantly higher in Group A than in Group B (p = 0.03). CONCLUSIONS: There were no differences in the amount of colonic ghrelin staining between healthy individuals and UC patients. Colonic ghrelin staining in UC patients seems to be associated with the increased activity of this disease.

Serum fibrosis markers could aid in the prediction of factor for successful oral antiviral treatment in hepatitis C.

BACKGROUND: It has been demonstrated that there may be a relationship between liver fibrosis and serum biomarkers. The aim of this study was to investigate pre- and postoral antiviral therapy levels of these biomarkers and their relationship with other fibrotic parameters in hepatitis C virus (HCV) patients. METHODS: The study group comprised HCV patients who were treated with oral antiviral regimens. Prior to, and 8 months after the treatment, serum biomarkers, including transforming growth factor-ß (TGF-ß), chitinase-3-like protein 1 (YKL-40), collagen type IV, matrix metalloproteinases (MMPs) and hyaluronic acid levels, were examined and fibrosis-4 (Fib-4) and aspartate aminotransferase to platelet ratio index (APRI) scores were calculated at the same times. RESULTS: In total, 45 HCV patients (aged between 27 and 86 years) participated. Of these 20 (44.4%) were cirrhotic and 25 (55.6%) were noncirrhotic. The concentrations of YKL-40 (P = 0.01) and TGF-ß (P = 0.032) after treatment were significantly higher than the pretreatment values, whereas hyaluronic acid concentrations decreased after treatment (P = 0.001). Noncirrhotic patients had significantly higher (P = 0.03) YKL-40 levels prior to therapy compared to cirrhotic patients. Median MMP-2 concentrations were higher in men than in women (P = 0.001). Prior to treatment, TGF-ß, YKL-40 and collagen type IV levels were negatively correlated with Fib-4 scores, whereas only TGF-ß and YKL-40 concentrations were negatively correlated with APRI scores. CONCLUSION: YKL-40, TGF ß and hyaluronic acid may be markers for fibrotic change during oral therapy for HCV. In particular, TGF ß concentrations correlated with fibrotic indices. However, these results should be confirmed and validated by further research.

The role of tacstd-2 level in hepatitis C patients (controlled clinical research).

Hepatitis C virus is one of the leading causes of liver cirrhosis and hepatocellular carcinoma. The tumor-associated calcium signal transducer 2 (Tacstd-2) molecule is thought to be involved in the expression of a number of molecules that facilitate transport of hepatitis C into the cell. The aim of this study was to investigate Tacstd-2 concentrations in hepatitis C patients, with and without cirrhosis, and compare with uninfected controls. Sixty-one hepatitis C patients and twenty-nine control (hepatitis C antibody negative patients with dyspeptic complaints) cases were recruited between 2014 and 2016. Tacstd-2 concentrations in all hepatitis C and control patients were measured and compared. In addition, cirrhotic and non-cirrhotic hepatitis C patients were compared in terms of Tacstd-2 concentration, and comparison was made between patients with high and low concentrations of Tacstd-2. The mean Tacstd-2 concentration of patients with Hepatitis C was 691.2 ± 473.3 ng/U was significantly higher (p = 0.043) than in the healthy control group (524 ± 290.1 ng/U). Although the Tacstd-2 value was higher in cirrhotic than the non-cirrhotic patient group, the difference was not statistically significant (p = 0.78). Liver transferase concentrations were higher in hepatitis C patients with a Tacstd-2 concentration <500 ng/U compared to those with a Tacstd-2 concentration >500 ng/U. In patients with hepatitis C, Tacstd-2 level was detected at higher serum concentrations than healthy individuals. The introduction of hepatitis C virus into the cell can be relatively easy in people with a higher serum concentration of Tacstd-2.

Paraoxonase-1 and arylesterase levels in patients with ulcerative colitis.

BACKGROUND AND STUDY AIMS: The role of oxidative stress in inflammatory bowel disease is increasingly recognised as an important factor. It is assumed that reduced levels of paraoxonase-1 (PON-1) and arylesterase (ARE) may lead to increased inflammation due to increased oxidative stress. This study aimed to investigate the relationship between ARE and PON-1 levels in ulcerative colitis (UC) patients and the difference in these levels in UC patients in comparison to the control group. PATIENTS AND METHODS: The study population consisted of 66 (73.3%) UC patients and 24 (26.7%) healthy individuals as the control group. The UC patients and the control group were compared in terms of PON-1 and ARE levels as oxidative stress markers. The UC patients were also grouped according to Mayo UC activity scores, and the differences in their PON-1 and ARE levels were assessed. RESULTS: The ARE values were statistically higher in the control group in comparison to the UC patients. Concentrations of PON-1 were not statistically different in the UC and control groups. The ARE value was found to be significantly lower in the UC patients with a haemoglobin level below 10 mg/dl. There was a correlation between the ARE and PON-1 values in the UC patients, but there was no difference between the ARE and PON-1 values, based on the UC patients' Mayo disease severity scores. CONCLUSION: This study found that the ARE values of UC patients were lower than those of healthy subjects. The same results could not be determined for PON-1. The data suggest that the antioxidative capacity of UC patients may be reduced.

Changes in Liver Tissue Trace Element Concentrations During Hepatitis B Viral Infection Treatment.

Approximately 350-400 million people in the world have Hbs Ag (hepatitis B virus surface antigen) positivity. In the international guidelines, the permanent suppression of replication in chronic hepatitis B virus (HBV) infection therapy is reported as the primary therapeutic goal. Trace elements play a key role in liver diseases. The aim of our study is to determine some trace element concentrations in the liver during HBV treatment periods. The measurement of 11 trace elements (manganese, lead, nickel, chromium, cadmium, iron, copper, zinc, silver, cobalt, and aluminum) was carried out by the method of inductively coupled plasma mass spectrometry in liver biopsy materials (before starting treatment and at the sixth month of the treatment period). There was an increase in zinc and copper concentrations in liver materials at the sixth month of treatment compared to the pre-treatment values (the median zinc value was 48.05 µg/g before treatment and 74.9 µg/g at 6 months after initial treatment, p = 0.035; median copper was 2.82 µg/g before treatment and 5.31 µg/g after 6 months, p = 0.002). General estimations indicated that zinc (p = 0.002), iron (p = 0.0244), copper (p = 0.0003), and aluminum (p = 0.0239) values may be effective in HAI (histological activity index) changes. Only iron levels could be at a very low level effective on the changes caused by fibrosis (p = 0.0002). Liver tissue zinc and copper levels increased in parallel with the improvement of inflammation in antiviral-treated HBV patients. In addition, the levels of zinc and copper in the liver tissue can be useful markers for liver tissue damage detection.

Liver tissue trace element levels in HepB patients and the relationship of these elements with histological injury in the liver and with clinical parameters.

AIM: In this study, the relationship of liver tissue trace element concentrations with hepatitis B disease and the effects of several environmental factors were analysed. METHOD: The liver tissue concentrations of Al, Fe, Cd, Mn, Cr, Cu, Pb, Ni, Zn, Ag, and Co were evaluated in 92 patients with hepatitis B using the Inductively Coupled Plasma - Mass Spectrometry (ICP/MS) method in the analyses. The patients were divided into the following two groups: low-high Ishak histologic activity index (HAI) (0-6: Low Histologic Activity, 7-18: High Histologic Activity) and low-high fibrosis (FS) (Fibrosis 1,1,2 and Fibrosis 3,4,5,6). The metal levels were compared between the groups. RESULTS: The Cd concentration was found to be statistically higher in the group with low HAI scores (p=0.019). The hepatic Cu concentration was found to be higher in women than in men (p=0.046). The hepatic Fe concentration was found to be higher in the group with increased FS compared to the group with decreased FS (p=0.033). Cd was found to be higher in patients who worked in positions involving exposure to heavy metals and in individuals with an ALT level above 40 IU/L (p=0.008). Several correlations have been found between the hepatic tissue metal levels in our study. In a linear regression analysis, Fe and Zn were found to be correlated with the fibrosis scores (p=<0.001 and p=0.029), and Cu was correlated with HAI (p=0.023). In the linear regression model, Ni (p=0.018) and Cr (p=0.011) were correlated with gender. There was a correlation between the hepatic Fe level and the location where hepatitis B patients were living (village/city) (p=0.001), frequency of fish consumption (p=0.045) and smoking (p=0.018) according to the linear regression analysis. Using a logistic regression analysis, Cr (p=0.029), Ni (p=0.031) and Pb (p=0.027) were found to be correlated with smoking habit, and Zn (p=0.010), Ag (p=0.026), Cd (p=0.007) and Al (p=0.005) were correlated with fish consumption. CONCLUSION: The liver tissue trace element levels are correlated with disease activity and histologic damage in patients with HepB disease. Additionally, smoking, the environment in which the patient works and the amount of fish consumption affect the accumulation of trace elements in the liver.

Peripheral FLT-3 ligand levels as a pathobiological parameter duringthe clinical course of acute myeloid leukemia.

BACKGROUND/AIM: FLT-3 ligand is a growth factor affecting the hematopoietic lineage. The aim of this study was to evaluate the variability of peripheral FLT-3 ligand during the clinical course of acute myeloid leukemia (AML) patients. MATERIALS AND METHODS: Twenty-four patients were enrolled in this study in order to assess alterations in the circulating levels of FLT-3 ligand during the clinical course of AML. RESULTS: We studied the association in the diagnostic period between the FLT-3 ligand and peripheral blood cells together with serum electrolytes. FLT-3 ligand levels (pg/mL) during the aplastic period due to remission induction and consolidation were higher than the levels at initial diagnosis. On the other hand, the diagnostic and remission induction values of leukocytes and FLT-3 ligand showed an inverse association. These results indicate to us that higher white cell counts are associated with lower FLT-3 ligand levels. We also found a reversed association between FLT-3 ligand and serum lactate dehydrogenase level. However, there was no association between FLT-3 ligand and other serum electrolyte levels. We also found higher FLT-3 ligand levels in male patients. CONCLUSION: Our study demonstrates the inverse proliferative action of FLT-3 ligand on the early myeloid lineage. In addition, this study showed us that FLT-3 receptor inhibition during chemotherapy-induced aplasia causes a compensative ligand overexpression.

The impact of anorectal biofeedback therapy on the quality of life of patients with dyssynergic defecation.

BACKGROUND/AIMS: Dyssynergic defecation is a common health problem affecting the quality of life of patients adversely. We aimed to evaluate the impact of biofeedback therapy on the quality of life of constipated patients due to dyssynergic defecation. MATERIALS AND METHODS: Constipated patients due to dyssynergic defecation were enrolled to the study. Patients having secondary causes of constipation and who didn't fulfill the eligible criteria were excluded. All the patients underwent three to ten sessions each of which was thirty minutes biofeedback therapy under the supervision of a trained nurse. After one month the patients were assessed for the control. The impact of biofeedback therapy on the quality of life of patients having dyssynergic defecation was assessed using the validated Medical Outcomes Study Short Form-36 (SF-36) questionnaire before and one month after therapy. RESULTS: Thirty-two patients (20 female 62.5%, 12 male 37.5% and mean age 48 (18-72) underwent three to ten sessions biofeedback therapy. Post-therapy improvements of subscores of SF-36 consists of eight domains were all statistically significant when we compared with the pre-therapy values. CONCLUSION: This study showed not only the effectiveness of biofeedback as a therapy modality for constipation but also its impact on the improvement of QOL of constipated patients due to dyssynergic defecation. Patients with chronic constipation not improved by dietary fiber and laxatives should be referred to specialized centers that have facilities for further anorectal physiological assessments.

Late Onset Remnant Gastric Cancer with Afferent Loop Syndrome 47 Years after Billroth II Surgery.

Remnant gastric cancer is a rare clinical entity. Herein we describe a patient with remnant gastric cancer that presented with afferent loop syndrome 47 years after Billroth II surgery. Symptoms of serious bilious vomiting were an indication to perform early endoscopic diagnosis, followed by complete gastric resection. In particular, patients that have undergone surgery due to benign indications should be examined endoscopically, even a long time after initial surgery.

Hepatic granulomas in Turkey: a 6-year clinicopathological study of 35 cases.

BACKGROUND/AIMS: Granulomas are focal aggregates of modified macrophages that are surrounded by a rim of lymphocytes and fibroblasts. The present study aimed to evaluate the prevalence and etiology of hepatic granulomas (HGs) in the Department of Gastroenterology with a wider population. MATERIALS AND METHODS: We performed a retrospective study on 2662 liver biopsy specimens analyzed between 2005 and 2011 at Gazi University Department of Gastroenterology to determine the presence of HGs. RESULTS: There were 16 cases with primary biliary cirrhosis, of whom 14 without any other causative etiology. There were 6 cases of sarcoidosis, 2 cases of Fasciola hepatica infection, 2 cases of hepatitis C, and 2 cases of hepatitis B. One case had both tuberculosis and rheumatoid arthritis and one case had both tuberculosis and brucellosis. There was also one case each of leishmaniasis and Hodgkin's lymphoma. The diagnosis of autoimmune hepatitis was found in two cases. One case had immune cholangiopathy. CONCLUSION: The leading causative etiology of HGs was primary biliary cirrhosis, followed by sarcoidosis. As a study performed in a center that accepts patient profiles throughout Turkey, tuberculosis took a minor part in HG etiology. A drug-affected or toxic case of HG was not observed.

Two cases of Wegener's granulomatosis with pancreatic pseudocyst treated by endoscopic ultrasonography (EUS)-guided drainage.

Wegener's granulomatosis is a systemic vasculitis with prominent involvement of the respiratory tract and kidney. There are 10 patients with Wegener's granulomatosis in the literature who were documented as acute pancreatitis. We present two cases with Wegener's granulomatosis presenting with acute pancreatitis and pancreatic pseudocyst. Endosonography-guided drainage of the pancreatic pseudocyst led to rapid clinical improvement. Pancreatic pseudocyst in Wegener's granulomatosis is not reported in the literature, and these are the first cases of Wegener's granulomatosis to be managed by endosonography-guided cyst drainage. The safety of endosonography-guided pancreatic pseudocyst drainage and the clinical features of the previous Wegener's granulomatosis cases with acute pancreatitis are discussed.

Daclatasvir Plus Asunaprevir Dual Therapy for Chronic HCV Genotype 1b Infection: Results of Turkish Early Access Program

Abstract: Background. Daclatasvir and asunaprevir dual therapy is approved for the treatment of HCV genotype 1b infection in several countries. Aim. To evaluate the efficacy and safety of daclatasvir and asunaprevir dual therapy in Turkish patients. Material and methods. Sixty-one patients with HCV genotype 1b were enrolled in the Turkish early access program. Most of the patients were in difficult-to-treat category. Patients were visited at each 4 week throughout the follow-up period. Laboratory findings and adverse events were recorded at each visit. Results. Fifty-seven of 61 enrolled patients completed 24 weeks of treatment. Two patients died as a result of underlying diseases at 12-14th weeks of treatment. Two patients stopped the treatment early as a consequence of virological breakthrough, and 2 patients had viral relapse at the post-treatment follow-up. Overall SVR12 rates were 90% (55/61) and 93.2% (55/59) according to intention-to-treat (ITT) and per protocol (PP) analysis respectively. In ITT analysis, SVR12 was achieved by 93% (13/14) in relapsers, 80% (12/15) in interferon-ineligible patients and 91% (20/22) in previous nonresponder patients. SVR12 rates were 86.5% and 91.4% in patients with cirrhosis according to ITT and PP analysis respectively. SVR12 was 95.8% in non-cirrhosis group in both analysis. Patients with previous protease inhibitor experience had an SVR12 of 87.5%. Common adverse events developed in 28.8% of patients. There were no treatment related severe adverse event or grade-4 laboratory abnormality. Conclusions. Daclatasvir and asunaprevir dual therapy is found to be effective and safe in difficult-to-treat Turkish patients with HCV genotype 1b infection.

Comparison of methods for detection of Blastocystis infection in routinely submitted stool samples, and also in IBS/IBD Patients in Ankara, Turkey.

BACKGROUND: This study compared diagnostic methods for identifying Blastocystis in stool samples, and evaluated the frequency of detection of Blastocystis in patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). RESULTS AND DISCUSSION: From a set of 105 stool specimens submitted for routine parasitological analysis, 30 were identified as positive for Blastocystis by the culture method. From that group of 30 positives, Lugol's stain, trichrome staining, and an immunofluorescence assay identified 11, 15, and 26 samples as positive respectively. Using culture as a standard, the sensitivity of Lugol's stain was 36.7%, trichrome staining was 50%, and the IFA stain was 86.7%. The specificity of Lugol's stain was 91%, trichrome staining was 100%, and the IFA stain was 97.3%. In the group of 27 IBS and IBD patients, using all methods combined, we detected Blastocystis in 67% (18/27) of the patients. Blastocystis was detected in 33% (2/6) of IBD patients and 76% (16/21) of IBS patients. For comparison, trichrome staining alone, the method most frequently used in many countries, would have only identified Blastocystis infection in 29% (6/21) of the IBS patients. No parasitic co-infections were identified in the IBS/IBD patients. Most Blastocystis-positive IBS/IBD patients were over 36 with an average length of illness of 4.9 years. CONCLUSIONS: Most IBS patients in this study were infected with Blastocystis. IFA staining may be a useful alternative to stool culture, especially if stool specimens have been chemically preserved.