Clinical and Laboratory Effects of Foodborne Illness in Children.

The World Health Organization estimates that 31 foodborne pathogen account for 600 million cases of illness annually. This study, conducted in a pediatric emergency department in Turkey, addresses the limited research on pediatric foodborne diseases (FD) in the country, exposing a significant knowledge gap. Analyzing 17,091 pediatric cases, 106 FD cases were identified, predominantly affecting boys (94.3%) with an average age of 7.65 ± 6.51 years. Remarkably, no patients required pediatric intensive care admission, and no mortalities were recorded. Hyponatremia emerged as a prevalent electrolyte disorder in pediatric FD, while hyperkalemia was notably observed in children under 5. The study emphasizes the severity of FD in children under 5, reflected in longer hospital stays, underscoring the urgent need for targeted interventions and improved detection methods in pediatric FD.

Baby-led complementary feeding: Randomized controlled study.

BACKGROUND: Baby-led weaning (BLW) is an approach to introducing solid foods to infants that gives control of the feeding process to the infant. Anecdotal evidence suggests that BLW is becoming popular with parents, but scientific research is limited to a few publications. This study assessed growth, hematological parameters and iron intake in 6-12-month-old infants fed by traditional or baby-led complementary feeding. METHODS: We recruited 280 healthy 5-6-month-old infants allocated to a control (traditional spoon feeding; TSF) group or an intervention (BLW) group in a randomized controlled trial. Infant growth, hematologic parameters and iron intake were evaluated at age 12 months. RESULTS: Infants in the TSF were significantly heavier than those in the BLW group. Mean weight in the BLW group was 10.4 ± 0.9 kg compared with 11.1 ± 0.5 kg in the TSF group. There was no statistically significant difference in the iron intake from complementary foods between the BLW (7.97 ± 1.37 mg/day) and TSF (7.90 ± 1.68 mg/day) participants who completed the diet records. Hematologic parameters were similar at 12 months. The incidence of choking reported in the weekly interviews was not different between the groups. CONCLUSIONS: To the best of our knowledge, this is the first randomized -controlled study to have examined the impact of weaning method on iron intake, hematological parameters and growth in breast-fed infants. BLW can be an alternative complementary feeding type without increasing the risk of iron deficiency, choking or growth impairment.

Contribution of diffusion weighted MRI to diagnosis and staging in gastric tumors and comparison with multi-detector computed tomography.

BACKGROUND: Diagnostic performance of Diffusion-Weighted magnetic resonance Imaging (DWI) and Multi-Detector Computed Tomography (MDCT) for TNM (Tumor, Lymph node, Metastasis) staging of gastric cancer was compared. PATIENTS AND METHODS: We used axial T2-weighted images and DWI (b-0,400 and b-800 s/mm2) protocol on 51 pre-operative patients who had been diagnosed with gastric cancer. We also conducted MDCT examinations on them. We looked for a signal increase in the series of DWI images. The depth of tumor invasion in the stomach wall (tumor (T) staging), the involvement of lymph nodes (nodal (N) staging), and the presence or absence of metastases (metastatic staging) in DWI and CT images according to the TNM staging system were evaluated. In each diagnosis of the tumors, sensitivity, specificity, positive and negative accuracy rates of DWI and MDCT examinations were found through a comparison with the results of the surgical pathology, which is the gold standard method. In addition to the compatibilities of each examination with surgical pathology, kappa statistics were used. RESULTS: Sensitivity and specificity of DWI and MDCT in lymph node staging were as follows: N1: DWI: 75.0%, 84.6%; MDCT: 66.7%, 82%;N2: DWI: 79.3%, 77.3%; MDCT: 69.0%, 68.2%; N3: DWI: 60.0%, 97.6%; MDCT: 50.0%, 90.2%. The diagnostic tool DWI seemed more compatible with the gold standard method (surgical pathology), especially in the staging of lymph node, when compared to MDCT. On the other hand, in T staging, the results of DWI and MDCT were better than the gold standard when the T stage increased. However, DWI did not demonstrate superiority to MDCT. The sensitivity and specificity of both imaging techniques for detecting distant metastasis were 100%. CONCLUSIONS: The diagnostic accuracy of DWI for TNM staging in gastric cancer before surgery is at a comparable level with MDCT and adding DWI to routine protocol of evaluating lymph nodes metastasis might increase diagnostic accuracy.

Impact of adjuvant treatment modalities on survival outcomes in curatively resected pancreatic and periampullary adenocarcinoma.

BACKGROUND: We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma (PAC). METHODS: A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013. RESULTS: Of 563 patients, 472 received adjuvant chemotherapy (CT) alone, chemoradiotherapy (CRT) alone, and chemoradiotherapy plus chemotherapy (CRT-CT) were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival (RFS) and overall survival (OS) were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant difference between groups when patients with node-negative disease or patients with or without positive surgical margins were considered. CONCLUSIONS: Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.

Impact of inflammatory markers on the prognosis of patients with operable breast cancer.

PURPOSE: To investigate the effect of inflammatory markers on the prognosis of patients with operable breast cancer. METHODS: This study was conducted on breast cancer patients followed up between December 2009 and December 2012 at the Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Medical School. A total of 704 patients with stages I to III disease whose inflammatory markers were assessed at the time of diagnosis were included the study. Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, ferritin, ß2 microglobulin (ß2-M), and lactate dehydrogenase (LDH) levels were evaluated as inflammatory markers. RESULTS: The median age at diagnosis was 50 years (range 25-92). Of the patients 42.8% were premenopausal and 48.2 % postmenopausal. Invasive ductal carcinoma was the most common histology (76.5 %). Serum ferritin, LDH, ß2-M, ESR, and CRP were higher than the normal values in 1.0, 4.3, 9.5, 32.4 and 36.4 % of the patients, respectively. Serum albumin levels were lower than the normal values in 1.7 % of the patients. The median patient follow-up period was 22 months (range 3-227). During follow-up, metastatic disease developed in 31 patients (4.4%) and 11 patients (1.56%) died due to disease progression. Two-year overall survival (OS) and disease free survival (DFS) rates were not statistically different among patients with normal and abnormal values with respect to albumin, ferritin, LDH, ß2-M, CRP, and ESR. CONCLUSION: Our study is the first study to investigate the effect of inflammatory markers on the prognosis of operable breast cancer patients. We showed that inflammatory markers such as ESR, CRP, ferritin, ß2-M, albumin and LDH have no effect on prognosis.

Blood and faecal lead levels in children with various functional gastrointestinal disorders.

INTRODUCTION: To investigate the blood lead levels (BLLs) and faecal lead levels (FLLs) in children with various functional gastrointestinal disorders (FGIDs) and compare them with controls. PATIENTS AND METHODS: One hundred and two children with FGIDs defined by the Rome IV criteria, aged 4-18 years, and one hundred and two sex matched healthy children were enrolled in the study. Children with FGIDs were divided into three subgroups as functional constipation (FC) (n = 36), functional abdominal pain (FAP) (n = 36) and functional nausea (FN) (n = 30). The lead levels were measured using atomic absorption spectrometer. RESULTS: The median BLLs in the FGIDs group was significantly higher than in controls (5.12 and 1.77 µg/dL, respectively). The BLLs were above 5 µg/dL in 51,9% of children with FGIDs. There was statistically significant difference in BLLs between FC subgroup and the other subgroups (FAP and FN) (p = 0.003, p < 0.001 respectively). The FLLs in the FGIDs group was significantly higher than in controls (28.08 and 0.01 µg/g, respectively). There was no significant difference in FLLs between FC subgroup and the other subgroups (p = 0.992, p = 0.989 respectively). No significant relation found between BLLs and FLLs of the FGIDs group (p = 0.123). CONCLUSION: This study revealed that children with FGIDs had higher BLLs and FLLs than controls and also more than half of children with FGIDs had BLLs ≥5 µg/dL which is considered as toxic level. These results might revive the question of whether or not clinicians need to evaluate routine BLLs in children with FGIDs.

Blood and Stool Arsenic Levels Are Decisive for Diagnosing Children's Functional Gastrointestinal Disease (FGD).

Pediatric gastroenteritis is a potentially fatal disease that accounts for 10% of childhood deaths. The main risk is environmental factors and nutrition. Arsenic (As) is commonly found in the earth's crust. As is an essential element that can form many organic compounds. In children, it causes diarrhea, gums, tongue lesions, diabetes, conjunctivitis, ocular opacity, and impaired immune response. It also causes low growth, mental retardation, and neurological problems. It is also known as the cause of many cancers that originate at an early age. Regionally, there is an iron and steel industry for almost a century. According to the Rome IV criteria, the blood and stools of 50 children aged 6-18 years, male and female, living in our province with functional gastrointestinal disease (FGD), were screened for As, and compared with the Healthy group (control) of 30 children. The results were evaluated with the Mann-Whitney Rank Sum Test. When blood and stool As values in males were compared with control samples, a high level of significance (p = 0.001) was found between both blood and stool As values in sick males and the control group (p < 0.005). In females, blood and stool As median values were also highly significant when compared with the control group (p = 0.001). According to these data, when the sick children (children with male and female gender) are compared with the healthy ones, the difference is highly significant (p < 0.005). High blood As levels in children indicate environmental pollution. It can be said that blood As levels are high as a result of food, water, and inhaler exposure. The presence of a high level of significant difference in stool means that the amount of As is high in the foods consumed daily. High levels of As are in blood and stools; It was evaluated that FGD could be the cause of nausea, diarrhea, vomiting, and colic. The increase in blood and stool As values due to environmental pollution is an important reason for FGD. For diseases of uncertain cause (such as FGD) resulting from chronic As exposure, blood and especially stool As values are more significant than urinary As levels. In conclusion, As a diagnostic criterion, it was concluded that blood and stool As values are an important marker in children with functional abdominal pain with other metals.

[Blood and faecal lead levels in children with various functional gastrointestinal disorders]. / Niveles séricos y fecales de plomo en niños con distintos trastornos digestivos funcionales.

INTRODUCTION: To investigate the blood lead levels (BLLs) and faecal lead levels (FLLs) in children with various functional gastrointestinal disorders (FGIDs) and compare them with controls. PATIENTS AND METHODS: One hundred and 2children with FGIDs defined by the Rome IV criteria, aged 4 -18 years, and one hundred and 2sex matched healthy children were enrolled in the study. Children with FGIDs were divided into 3subgroups as functional constipation (FC) (n=36), functional abdominal pain (FAP) (n=36) and functional náusea (FN) (n=30). The lead levels were measured using atomic absorption spectrometer. RESULTS: The median BLLs in the FGIDs group was significantly higher than in controls (5.12 and 1.77µg/dL, respectively). The BLLs were above 5µg/dL in 51,9% of children with FGIDs. There was statistically significant difference in BLLs between FC subgroup and the other subgroups (FAP and FN) (P=.003, P<.001 respectively). The FLLs in the FGIDs group was significantly higher than in controls (28.08 and 0.01µg/g, respectively). There was no significant difference in FLLs between FC subgroup and the other subgroups (P=.992, P=.989 respectively). No significant relation found between BLLs and FLLs of the FGIDs group (P =.123). CONCLUSION: This study revealed that children with FGIDs had higher BLLs and FLLs than controls and also more than half of children with FGIDs had BLLs ≥5µg/dL which is toxic level. These results might revive the question of whether or not clinician need to evaluate routine BLLs in children with FGIDs.

Evaluation of interleukin 8 polymorphisms (-251T/A and +781C/T) in patients with hepatocellular carcinoma: a meta-analysis.

AIM OF THE STUDY: We reported the association between interleukin 8 (IL-8) polymorphisms (-251T/A and +781C/T) and hepatocellular carcinoma (HCC) risk in a meta-analysis. MATERIAL AND METHODS: Scopus, PubMed, Web of Science, and Cochrane Library databases were searched until 21 November 2020. The analyses were performed by RevMan 5.3 software using odds ratios (ORs) and 95% confidence intervals (CIs). Also, the analysis of publication bias was performed by CMA 2.0 software. RESULTS: Searching databases/sources, five articles including ten studies were entered into the meta-analysis. The pooled ORs for -251T/A polymorphism were 1.07 (p = 0.55), 1.04 (p = 0.75), 1.31 (p = 0.24), 1.24 (p = 0.31), and 1.85 (p = 0.29) for allele, homozygote, heterozygote, recessive and dominant models, respectively. With regards to +781C/T polymorphism, the pooled ORs were 0.74 (p = 0.07), 0.53 (p = 0.03), 0.83 (p = 0.41), 0.75 (p = 0.19), and 0.57 (p = 0.02) for allele, homozygote, heterozygote, recessive, and dominant models, respectively. CONCLUSIONS: The findings of the meta-analysis showed a lack of significant association between IL-8 (-251T/A) polymorphism and the HCC risk, whereas the TT genotype of IL-8 (+781C/T) polymorphism had a protective role in HCC.

The vitamin D status and serum eosinophilic cationic protein levels in infants with cow's milk protein allergy.

Eosinophil cationic protein (ECP) is a cytotoxic protein released from eosinophils. The level of ECP increases in some allergic diseases. Recently, vitamin D deficiency has been suggested to be a risk factor for childhood allergic disease. The first aim of the study is to measure the serum vitamin D levels and ECP in infants with cow's milk protein allergy (CMPA) and compare them with controls. The second aim of this study is to investigate whether vitamin D levels are correlated with ECP or not. Sixty-two infants with CMPA were compared to 58 healthy, similar to distribution of age and sex normal infants as controls. The serum ECP levels were detected by an immunoassay system. Serum 25(OH)D levels were measured by using an enzyme-linked immunoassay kit. Vitamin D deficiency was defined as a serum 25(OH)D level of < 10 ng/mL and sufficient 30 ng/mL. The median serum ECP level in the CMPA group was significantly higher than in the control group (51.45 and 17.55 ng/mL, respectively, P = 0.001). There were no significant differences between groups with regards to median 25(OH)D levels (29.31 ± 1.67 and 27.32 ± 1.41 ng/mL, respectively, P = 0.646). The serum 25(OH)D levels were under 30 ng/mL in 38 of infants with CMPA (61.2%) and in 32 of controls (55.1%). Correlation analysis between the serum 25(OH)D level and ECP of infants with CMPA have revealed no significant relation (P = 0.888). Our results do not support the hypothesis that vitamin D deficiency may be a risk factor for CMPA.

SLC26A3 mutation in Turkish neonate and her sibling with congenital chloride diarrhea.

Congenital chloride diarrhea is a rare cause of severe infantile diarrhea with excessive chloride excretion. Mutations in the SLC26A3 gene cause congenital chloride diarrhea. It generally becomes apparent in the neonatal period and is characterized by electrolyte imbalances, metabolic alkalosis, and failure to thrive. The diagnosis of congenital chloride diarrhea is based on detecting excessive chloride in the stool (90 mmol/L). We report a Turkish neonate with congenital chloride diarrhea whose sibling had the same disease. The newborn was born by cesarean delivery. Diarrhea, vomiting, and weight loss started soon after birth. She was diagnosed as having congenital chloride diarrhea based on its typical clinical signs and a high concentration of stool chloride and was confirmed by genetic analysis. She was treated by means of salt supplementations and lansoprazole. Family history may play an important role in the early diagnosis because the disease is inherited autosomal recessively.

Assessment of balance skills and falling risk in children with congenital bilateral profound sensorineural hearing loss.

OBJECTIVE: To evaluate the balance skills and falling risk in children with a congenital bilateral profound sensorineural hearing loss (CBPSNHL). METHODS: 25 children with CBPSNHL and healthy 25 children with similar age and gender were included in the study. The flamingo balance test, the tandem stance test, and the one-leg standing test were performed to assess the patients' static balance skills. The pediatric balance scale (PBS) was used to evaluate the dynamic balance. Visual analog scale (VAS) was applied to the patients assess the frequency of falls. RESULTS: The flamingo balance test, the tandem stance test, and the one-leg standing test in the children with CBPSNHL were all significantly worse than the control group. Although the scores of PBS in patients with CBPSNHL were significantly lower than the control group (p < 0.001), the results of both groups were consistent with a low risk of falls. There was no significant difference between the VAS scores indicating the frequency of falls among the groups (p = 0.552). CONCLUSION: Static and dynamic balance skills of the children with CBPSNHL are significantly impaired compared to their healthy peers. Children with CBPSNHL also have a lower risk of falling just like their healthy peers and there is no significant difference between their falling frequencies. Balance skills of children with CBPSNHL can be assessed quickly and effectively on a hard floor (eyes closed), with a tandem standing test or a one-leg standing test.

Mean platelet volume and red cell distribution width as potential new biomarkers in children with gastroesophageal reflux disease.

The aim of this study was to calculate the corrected rate of reflux in children with gastroesophageal reflux (GER)-like complaints by 24-hour pH monitoring and esophagogastroduodenoscopy (EGD), and to determine the utility of mean platelet volume (MPV) and red cell distribution width (RDW) as diagnostic biomarkers of GER disease (GERD) in children. The subjects in this prospective study were 109 children, 6 to 18 years old. Of them, 74 subjects were with GER symptoms and 35 healthy controls. The subjects were divided into three groups: those who underwent 24-hour pH monitoring (Group 1), those who underwent EGD together with pH monitoring (Group 2), and the healthy controls (Group 3). The results of pH monitoring and EGD and hematological parameters with controls were compared between Groups 1 and 2. In Groups 1 and 2, the overall rate of reflux was 40%, of esophagitis was 27.8%, and of Helicobacter pylori infection was 31.2%. The MPV and RDW cut-offs in subjects with reflux were ≤ 8.97 (sensitivity 89%, specificity 89%) and ≤ 12.78 (sensitivity 80%, specificity 97%), with an area under the Receiver Operating Characteristic (ROC) curve ± standard error (AUC ± SE) = 0.917 ± 0.027 (P < 0.001) and AUC ± SE = 0.866 ± 0.036 (P < 0.001), respectively. The endoscopic procedures are not practical due to being invasive and expensive. However, hemogram is a simple test which can be performed in an outpatient clinic. MPV and RDW calculated in hemogram could be easy, cost-effective, and high sensitive new biomarkers that can be used in children with GERD.

Spinal Metastasis of Unknown Primary Accompanied by Neurologic Deficit or Vertebral Instability.

BACKGROUND AND OBJECTIVE: Spinal bone metastases are common. They are mostly localized to the lumbar, thoracic, and cervical spine. The most common primaries to result in spinal metastases include lung, breast, and prostate carcinomas in adults as opposed to leukemia, Ewing sarcoma, rhabdomyosarcoma, and neuroblastoma in children. In patients diagnosed with cancer, bone metastases are found in 40% and spinal metastases in 10%. In this study, we reviewed 25 patients diagnosed with a spinal metastasis of unknown primary who presented with low back pain or acute-onset neurologic deficits and underwent operative treatment. METHODS: The retrospective study included 25 patients with a spinal metastasis of unknown primary who presented to our clinic with acute-onset vertebral fracture or neurologic deficit. Statistical descriptions were obtained for each patient. Survival analysis was performed using the Kaplan-Meier method. RESULTS: The 25 patients included 17 men (68%) and 8 women (32%), with a mean age of 55 years (range, 14-81 years). Eleven patients (44%) presented with varying degrees of motor deficits ranging from flaccid paralysis to paraplegia. Motor deficits were completely reversed in 4 patients postoperatively. The tumors were localized to the upper thoracic spine (T1-4) in 2 patients, in the midthoracic spine (T5-8) in 2 patients, in the lower thoracic spine (T9-12) in 8 patients, in the cervical 7 in 1 patient, and in the lumbar spine in 12 patients. In 10 patients, the tumor affected multiple spinal regions. Nonosseous tumors were not present in 10 patients. Ten patients had an extradural tumor. Costal involvement was detected in 2 patients. The tumors were pathologically identified as lung cancer (n = 3), lymphoma (n = 5), breast cancer (n = 3), gastric cancer (n = 2), liver cancer (n = 2), prostate cancer (n = 2), renal cell carcinoma (n = 2), malignant melanoma (n = 1), plasmacytoma (n = 1), bladder cancer (n = 1), paraganglioma (n = 1), Ewing sarcoma (n = 1), and yolk sac carcinoma (n = 1). Posterior instrumentation was performed in patients with instability. In addition, decompression was performed in patients with neurologic deficit. CONCLUSIONS: Considering that 10% of patients with cancer are diagnosed by vertebral metastasis, presence of malignancy should be suspected and a detailed examination should be performed in patients presenting with vertebral fractures caused by no or minor trauma. Moreover, in patients presenting with neurologic deficit, soft tissue metastases leading to spinal cord compression should be kept in mind and further examinations should be promptly administered.

Associations between the standardized uptake value of (18)F-FDG PET/CT and demographic, clinical, pathological, radiological factors in lung cancer.

OBJECTIVES: (18)F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is extensively used to diagnose and stage of lung cancer. The aim of the current study was to investigate the correlation of demographic, clinical, pathological and radiological factors with primer tumor FDG Uptake in patients with lung cancer. MATERIALS AND METHODS: This cross-sectional, clinical study was performed on a total of 57 lung cancer patients newly diagnosed that underwent FDG PET/CT. In addition to descriptive variables, histopathological diagnosis, tumor site and size, hemoglobin level, red cell distribution width, neutrophil to lymphocyte ratio were noted for each patient. The correlation of these variables to SUVmax values in FDG PET/CT was investigated. RESULTS: A total of 57 patients (4 women, 53 men) with an average age of 60.8±9.4 (range: 33-89) participated in the study. Histopathological diagnoses were consistent with squamous cell carcinoma (28, 49.1%), adenocarcinoma (15, 26.3%) and small cell cancer (14, 24.6%). The SUVmax of primary tumor was positively correlated with tumor size (P<0.001). The tumor SUVmax of squamous cell carcinoma (SqCC) (17.49±8.37) was higher than that of adenocarcinoma (AC) (12.80±4.77) and small cell carcinoma (SCC) (12.40±5.80) (P=0.038). CONCLUSION: SUVmax value was significantly higher for squamous cell carcinoma and it SUVmax values in PET scans was found to be positively correlated with tumor size. This study suggests that, tumor size and histologic subtype had influences upon FDG uptake in lung cancer.

Nodular regenerative hyperplasia of the liver: a case report.

Nodular regenerative hyperplasia of the liver is characterized by hepatocellular nodules distributed throughout the liver in the absence of fibrous septa between the nodules. In the literature, most reports have been single cases so that the prevalence and clinical significance of the disease is not exactly known. The critical lesion is obliterative portal venopathy which is obstruction to terminal radicals of hepatic arterioles and portal venules, possibly secondary to endothelial cell damage. Resultant hepatic ischemia may be responsible for induction of the nodular regenerative change. Portal hypertension which is secondary to nodular regenerative hyperplasia and is often complicated by bleeding esophageal varices. We report a rare case of nodular regarative hyperplasia of the liver, with onset of symptom in childhood.

Multicenter epidemiologic study on hepatocellular carcinoma in Turkey.

BACKGROUND: Hepatocellular cancer (HCC) is one of the important health problems in Turkey, being very common and highly lethal. The aim of this study was to determine clinical, demographic features and risk factors. MATERIALS AND METHODS: Nine hundred and sixth-three patients with HCC from 13 cities in Turkey were included in this study. RESULTS: Only 205 (21%) of the 963 patients were women, with a male:female predominance of 4.8:1 and a median age of 61 years. The etiologic risk factors for HCC were hepatitis B in 555 patients (57.6%), 453 (81%) in men, and 102 (19%) in women, again with male predominance, hepatitis C in 159 (16.5%), (14.9% and 22.4%, with a higher incidence in women), and chronic alcohol abuse (more than ten years) in 137 (14.2%) (16.8% and 4.9%, higher in males). The Child-Pugh score paralleled with advanced disease stage amd also a high level of AFP. CONCLUSIONS: According to our findings the viral etiology (hepatitis B and hepatitis C infections) in the Turkish population was the most important factor in HCC development, with alcohol abuse as the third risk factor. The Child-Pugh classification and AFP levels were determined to be important prognostic factors in HCC patients.