Can quantitative surface antigen levels and systemic immune-inflammation index be predictive as a new indicator for the initiation of treatment in chronic hepatitis b?

OBJECTIVES: The natural history of chronic HBV infection (CHB) is generally divided into four phases: HBeAg-positive chronic HBV infection (EPCI) and -hepatitis (EPCH), HBeAg-negative chronic HBV infection (ENCI) and -hepatitis (ENCH). This study aimed to investigate changes in serum quantitative surface antigen (qHBsAg), systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) in a large number of CHB patients. METHOD: Three hundred seventy-two CHB patients who underwent liver biopsy between January 2015 and February 2020 were evaluated. RESULTS: The SII-values were strongly significant between EPCI-EPCH ( P = 0.002), however, there was significant difference between ENCI-ENCH ( P = 0.025). Considering the SIRI results, there was a significant difference between both EPCI-EPCH ( P = 0.009) and ENCI-ENCH ( P = 0.118). In HBeAg-positive patients HBV-DNA, qHBsAg, and SII were found to be predictive ( P = 0.029, P = 0.039, P = 0.027, respectively) while in HBeAg-negative patients, age, AST, HBV-DNA, qHBsAg, SII, and SIRI were found to be predictive ( P = 0.047, P = 0.084, P = <0.001, P = 0.001, P = 0.012, P = 0.002, respectively). In EPCH phase, whereby accuracy rate results of HBV-DNA, qHBsAg, and SII were 75.3%, 73.4%, and 60.4%, respectively, while in the ENCH phase the accuracy rates of age, AST, HBV-DNA, qHBsAg, SII, and SIRI values were 57.8%, 65.6%, 68.3%, 63.8%, 57.3% and 53.2%, respectively. CONCLUSION: HBV-DNA, qHBsAg, and SII are predictive in EPCH patients. Age, AST, HBV-DNA, qHBsAg, SII and SIRI are all predictive in ENCH patients. In patients with CHB, we recommend using SII to distinguish between EPCI-EPCH and ENCI-ENCH. Based on its sensitivity and features, we believe that qHBsAg and SII are suitable measuring instruments in discrimination both of EPCI-EPCH and ENCI-ENCH.

Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome.

INTRODUCTION: HELLP (hemolysis, elevated liver enzyme levels, low platelet counts)-syndrome is a rare but dramatic pregnancy-related illness. The difficult part of this syndrome is the lack of standardised diagnostic criterias and tests to be used to predict it. The aim of this study is determining the role of APRI score in the diagnosis of HELLP syndrome. MATERIAL AND METHODS: In this cross sectional, retrospective study, patients with HELLP syndrome as case group and age-matched healthy pregnants at the similar pregnancy trimester as control group were included between January 12,017 and May 31, 2018. Data including sex, age, laboratory values, prognosis were recorded from the computerized system of the hospital. The p-value <0.05 was considered statistically significant. RESULTS: 40 patients with HELLP syndrome and 124 age-matched healthy pregnants included in the study. There was a statistically significant difference between control group and HELLP patients in terms of the mean urinary protein, platelet count, ALT, AST, creatinin, D dimer levels and also the mean APRI score. In the multivariate regression analysis, APRI score was found a better predictor than AST and both were in a good significant in predicting HELLP. On the ROC curve in order to distinguish the patients with HELLP from the control group for AST and APRI score, the sensitivity was found to be 71.7% and 82.6%, specificity to be 91.2% and 87.6% respectively. Maternal mortality rate of HELLP syndrome was 10%. CONCLUSION: We concluded that the APRI score was robustly predicted HELLP syndrome than AST alone in this study. Further studies are needed to support our data with prospective, multicentre, larger patient groups.

Percutaneous endoscopic gastrostomy feeding is beneficial in patients with advanced dementia.

BACKGROUND AND OBJECTIVES: We aimed to show the long-term results of patients who received percutaneous endoscopic gastrostomy (PEG) tubes and to evaluate the usefulness of this method in advanced dementia patients, which is considered to be of controversial benefit in the literature. Therefore, we compared three groups of patients: advanced dementia patients fed via PEG, stroke patients fed via PEG and advanced dementia patients not fed via PEG. METHODS AND STUDY DESIGN: In total, 305 files of patients who underwent PEG implantation were screened retrospectively, and 283 were analyzed. A total of 93 advanced dementia patients who were not fed via PEG were included as the control group, and the PEG-fed group was compared in terms of mortality and CRP levels with the advanced dementia control group not fed via PEG. RESULTS: The median length of PEG stay was 9 months. In total, 49 (17.5%) patients developed complications. Mortality (p=0.0002) and CRP levels (p=0.01) were statistically significant in the advanced dementia group not fed via PEG. The group with stroke and the dementia patients were analyzed regarding length of PEG stay, complications and mortality. The length of PEG stay, rate of complications and mortality in the stroke group were not found to be statistically significant in comparison to the dementia group. CONCLUSIONS: Mortality and CRP levels were statistically significantly higher in the advanced dementia group not fed via PEG. The mortality and rate of complications in the dementia group were similar to those in the stroke group. Feeding with PEG-tubes is a proper and preferable method for advanced dementia patients.