Possible drug-drug interactions among elderly patients receiving antiviral therapy for chronic hepatitis B.

AIM: To identify possible drug-drug interactions in patients taking medications for other comorbidities while on antiviral therapy for chronic hepatitis B. METHODS: The study enrolled patients with chronic hepatitis B aged ≥60 years who were treated with antiviral therapy in five hospitals in Turkey between January 1 and March 1, 2023. The Lexicomp® Drug Interactions program was used to identify possible drug-drug interactions. RESULTS: The study included 213 patients (119 [55.9%] men). The mean age was 68.5 years. A potential drug-drug interaction was identified in 112 patients (52.6%). The most common type of interaction was type C ("follow the treatment") (71.54%). The number of potential drug-drug interactions increased with an increase in the number of drugs used by the patients. A robust and affirmative correlation was observed between the number of medications used and the number of possible drug-drug interactions (r=0.791, P<0.001). Adverse interactions (interactions of types C and D, 3.7% of cases) were limited to patients receiving tenofovir disoproxil fumarate. CONCLUSION: Nonsteroidal anti-inflammatory medications should be used cautiously in elderly patients with chronic hepatitis B treated with tenofovir disoproxil fumarate due to the increased risk of renal toxicity.

Effects of Sandbag-Free Follow-up After Manual Compression in Patients Who Underwent Transfemoral Access for Percutaneous Intervention.

OBJECTIVE: Femoral access site complications (ASC) are frequent yet significant conditions associated with percutaneous intervention procedures that affect patient-physician comfort. In this study, we compared ASC rates between patients who received compression with a sandbag, the standard practice in many clinics, and patients monitored solely with bedrest without sandbag compression. METHODS: This study included patients undergoing any transfemoral percutaneous intervention (mostly coronary interventions) between April 2019 and May 2023 at our clinic. Patients were classified into two groups: those monitored without a sandbag (n = 160) and those with a sandbag (n = 158). ASC rates (ecchymosis, pseudoaneurysm, hematoma, bleeding) were compared between the two groups. RESULTS: No differences were observed between the two groups in gender, age, sheath size, and bed rest times. Complications were observed in 16.9% (n = 27) of patients without sandbags and 25.3% (n = 40) of patients with sandbags. The most common complication was ecchymosis, seen in 10.6% (n = 17) of the no-sandbag group and 13.9% (n = 22) of the sandbag group. CONCLUSION: Following manual compression after femoral sheath removal, patients receiving bedrest without sandbag use are less likely to develop ASC. Additionally, dismissing sandbag use leads to a significant increase in patient comfort.

Confounding giant right atrial mass.

BACKGROUND: Primary cardiac tumors are uncommon, with approximately 70-80% classified as benign. Myxomas constitute roughly half of all benign cardiac tumors, while cardiac hydatid cysts are exceptionally rare. Shortness of breath is a prominent symptom associated with these conditions. Echocardiography serves as the primary diagnostic tool, enabling early detection. The preferred course of action involves the surgical excision of the mass. CASE PRESENTATION: Our first case, a 51-year-old female presented to the cardiology outpatient clinic with complaints of shortness of breath and palpitations persisting for 3 months. Physical examination and tests were within normal limits. Echocardiography revealed a right atrial myxoma measuring 65 * 35 mm. Despite not affecting valve and ventricular functions, the mass was surgically resected. Our second case, a 55-year-old male admitted to the cardiology clinic with recurrent fever, shortness of breath, and chest pain. Physical examination and tests were normal. Echocardiography revealed an echogenic mass with a septate appearance adhering to the free wall of the right atrium. The patient, diagnosed with a hydatid cyst, underwent surgical resection. CONCLUSIONS: We came across two different cases of RA masses which happened to be myxoma and hydatid cysts, and we managed accordingly. The right atrial myxomas typically present with nonspecific shortness of breath unless they cause valve obstruction. In cases where clinical findings suggest infection in the right atrial masses, it is essential to consider hydatid cyst as a potential diagnosis alongside the initial consideration of vegetation.

The effect of uric acid and albumin ratio in undergoing lower extremity endovascular interventions for peripheral arterial disease related contrast induced nephropathy.

BACKGROUND: Among patients undergoing percutaneous vascular intervention, contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. Serum uric acid/albumin ratio (UAR) has emerged as a new marker associated with poor cardiovascular outcomes. We aimed to evaluate the relationship between UAR and CIN occurrence in patients treated for peripheral artery disease. METHODS: Patients underwent percutaneous intervention due to peripheral artery disease were enrolled. The primary endpoint was development of contrast related nephropathy. Patients were divided into 2 groups according to the CIN occurrence. RESULTS: A total of 663 patients were enrolled and mean age was 62 ± 10 years. After the intervention, 45 patients had CIN and 618 patients did not have CIN. Logistic regression analysis was performed to define the parameters of CIN. Male gender, diabetes, UAR, contrast volume, presence of coronary artery disease, and C-reactive protein levels were found significant in univariate analysis. However, only UAR was found significant in multivariate analysis (odds ratio 95% confidence interval: 3.426 (1.059-11.079), (P = 0.040)).Therefore, it is the only independent predictor for occurrence of CIN. CONCLUSIONS: UAR is a reliable scoring system, which predicts CIN in such patient group. This score is not only cost-effective also simple, which can be easily applied into the clinical practice.

Systemic Immune-Inflammation Index as a Potential Biomarker for Assessing Disease Activity and Predicting Proteinuria Development in Systemic Lupus Erythematosus.

Background Systemic lupus erythematosus (SLE) is a complex autoimmune disease with varied clinical manifestations affecting multiple organ systems. This study aimed to investigate the association between the systemic immune-inflammation index (SII) and disease activity, as well as proteinuria levels in patients with SLE. Methodology A total of 141 patients diagnosed with SLE and 99 control subjects were included in this retrospective study. SLE patients were divided into two groups based on the presence (52) or absence (89) of proteinuria. Demographic data, laboratory parameters, and disease activity scores were recorded. SII was calculated based on peripheral blood counts. Statistical analysis was performed to assess the relationship between SII levels and disease activity, as well as proteinuria. Results The statistical analysis among the three groups revealed that SII was significantly different in all three groups (p < 0.001). Moreover, within the SLE cohort, patients with proteinuria had significantly higher SII levels compared to those without proteinuria (p = 0.012). Correlation analysis revealed a positive association between SII and both proteinuria and Systemic Lupus Erythematosus Disease Activity Index 2000 (r = 0.215; p = 0.011 and r = 0.186; p = 0.028, respectively). Receiver operating characteristic analysis demonstrated that SII had potential clinical value in diagnosing SLE and predicting proteinuria development. Conclusions The findings of this study suggest that SII may serve as a useful biomarker for assessing disease activity and predicting proteinuria development in patients with SLE. Further research is warranted to validate these findings and explore the utility of SII in clinical practice for monitoring disease progression and treatment response in SLE.

The role of clinical and laboratory finding in the differential diagnosis of Hantavirus and Leptospirosis infections.

BACKGROUND OBJECTIVES: Hantavirus and leptospirosis infections are zoonotic diseases with similar clinical and laboratory findings. The aim of this study is identifying the distinguishing features of these two diseases, for which a definitive diagnosis can take a long time. METHODS: Between September 2021 and June 2023, a total of 45 patients who were admitted to our hospital and were diagnosed with HFRS or leptospirosis were retrospectively evaluated. Patients were compared in terms of demographic data, clinical, and laboratory parameters. The role of these variables in predicting HFRS or leptospirosis was investigated. The two diseases were compared with regard to outcomes. Receiver operating characteristics were employed for the calculation of cut-off values, sensitivity, specificity, and positive and negative predictive values for parameters showing significant differences. A statistical significance level of p<0.05 was considered. RESULTS: Fifteen patients diagnosed with HFRS and thirty patients diagnosed with leptospirosis were included in the study. In both groups, hospital admissions were observed with non-specific and similar symptoms. There was no statistically significant difference observed between the two groups in terms of length of hospital stay, blood product transfusion, requirement for hemodialysis, intensive care unit admission, the rate of return to normal renal function and mortality. Elevated ferritin levels were statistically significant in favor of HFRS, while lymphopenia, elevated bilirubin, CRP, and ESR were statistically significant in favor of leptospirosis. INTERPRETATION CONCLUSION: The use of laboratory findings and clinical symptoms can aid in the challenging task of accurately diagnosing and using appropriate treatment for these two diseases.

Can we predict bleeding at admission in Crimean-Congo hemorrhagic fever?

BACKGROUND: In Crimean-Congo hemorrhagic fever, bleeding has a significant impact on the prognosis of the disease. In our study, we aimed to identify independent risk factors for the development of bleeding in Crimean-Congo hemorrhagic fever and to contribute to the management of the disease. METHODS: Cases with a definitive diagnosis of Crimean-Congo hemorrhagic fever were divided into two groups: those who developed bleeding and those who did not. Demographic, clinical and laboratory parameters were subjected to logistic regression analysis in terms of risk factors for bleeding development. Cut-off values for numerical variables were determined by receiver operating characteristics. RESULTS: A total of 74 patients diagnosed with CCHF were included in the study. Bleeding occurred in at least one defined focus in 21 patients. In the multivariate logistic regression model, procalcitonin, days from symptom onset to admission, platelet count, and d-dimer were identified as independent risk factors for bleeding development. Procalcitonin had the most significant effect, with an approximately 5.3-fold increase in bleeding risk for each unit increase in its level. For discriminate bleeding, LDH and ferritin exhibited the highest sensitivity, while procalcitonin showed the highest specificity. CONCLUSION: This study demonstrates the potential use of specific clinical and laboratory variables to predict bleeding development in CCHF patients. Procalcitonin elevation and the time from symptom onset to hospital admission have a significant effect in predicting bleeding.

The effect of preemptive retrolaminar block on lumbar spinal decompression surgery.

PURPOSE: Spinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption. METHODS: The sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome. RESULTS: There was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33-3.509)] and movement [2.40 (1.20-4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100-300); Group 2: 37.5 (0-200); p < 0.001]. CONCLUSION: Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907).

Acute hepatitis B outbreak in a nursing home for the disabled in Türkiye.

Background: Although hepatitis B is vaccine-preventable, it remains a significant health problem. To the best of our knowledge, this is the first hepatitis B outbreak report from Türkiye. Aims: To investigate the cause of hepatitis B outbreak in a nursing home for the disabled and make recommendations for prevention. Methods: An outbreak of acute hepatitis B was declared in a nursing home for the disabled following the admission of 3 patients from the home in a hospital. Collaborative response was initiated with the Provincial Health Directorate through the Public Health Infectious Diseases Department. We began tracking the infection and monitoring active cases. Audits and controls were carried out to determine the source, establish protection and control measures, and prevent further transmission. Results: Six of the 65 nursing home residents were diagnosed with acute hepatitis B. Four of them had diabetes and their blood glucose levels were monitored for at least 12 months. Two of the patients had received dental treatment in the last 6 months. The frequency of both variables, which may be an indication of the transmission route, was statistically significantly greater in the acute hepatitis B group. All the patients who could be sequenced were identified as genotype D. While 3 patients recovered fully, 2 were diagnosed with chronic hepatitis B and one died due to fulminant hepatitis. Conclusion: Standard routine immunization should be implemented as a preventive measure for acute hepatitis B. Frequent supervision and training on hygiene practices and safety precautions should be conducted for care staff working in collective residential facilities.

Investigation of hematologic findings related to brucellosis in Anatolian region.

OBJECTIVES: To investigate the prevalence of hematologic findings and the relationship between hemogram parameters and brucellosis stages in patients. METHODS: This multi-center study included patients older than 16 years of age who were followed up with a diagnosis of brucellosis. Patients' results, including white blood cell, hemoglobin, neutrophil, lymphocyte, monocyte, mean platelet volume, platelet and eosinophil counts were analyzed at the initial diagnosis. RESULTS: In this study 51.3% of the patients diagnosed with brucellosis were male. The age median was 45 years for female and 41 years for male. A total of 55.1% of the patients had acute brucellosis, 28.2% had subacute, 7.4% had chronic and 9% had relapse. The most common hematologic findings in brucellosis patients were anemia (25.9%), monocytosis (15.9%), eosinopenia (10.3%), and leukocytosis (7.1%). Pancytopenia occurred in 0.8% of patients and was more prominent in the acute phase. The acute brucellosis group had lower white blood cell, hemoglobin, neutrophil, eosinophil, and platelet counts and mean platelet volume, and higher monocyte counts compared to subacute and chronic subgroups. CONCLUSION: It was noteworthy that in addition to anemia and monocytosis, eosinopenia was third most prominent laboratory findings in the study. Pancytopenia and thrombocytopenia rates were low.

Surgical Antimicrobial Prophylaxis Compliance in Turkey: Data from the Prospective, Observational, Multicenter Survey Including 7,978 Surgical Patients.

Background: Surgical antimicrobial prophylaxis (SAP) is the peri-operative administration of antimicrobial agents. Compliance rates vary worldwide from 15% to 84.3%, with studies in Turkey not exceeding 35%. The aim of this multicenter study was to determine the rate of appropriate antibiotic class, timing, and duration as well as discharge prescriptions in Turkey. Thus, we aimed to determine the rate of full compliance with SAP procedures in our country Patients and Methods: This multicenter, prospective, observational, descriptive study was conducted in 47 hospitals from 28 provinces in seven different regions of Turkey. Patients over 18 years of age in all surgical units between June 6, 2022, and June 10, 2022, were included in the study. Results: Of the 7,978 patients included in the study, 332 were excluded from further analyses because of pre-existing infection, and SAP compliance analyses were performed on the remaining 7,646 cases. The antibiotic most commonly used for SAP was cefazolin (n = 4,701; 61.5%), followed by third-generation cephalosporins (n = 596; 7.8%). The most common time to start SAP was within 30 minutes before surgery (n = 2,252; 32.5%), followed by 30 to 60 minutes before surgery (n = 1,638; 23.6%). Surgical antimicrobial prophylaxis duration was <24 hours in 3,516 (50.7%) patients and prolonged until discharge in 1,505 (21.7%) patients. Finally, the actual proportion of patients compliant with SAP was 19% (n = 1,452) after omitting 4,458 (58.3%) patients who were prescribed oral antibiotic agents at discharge as part of a prolonged SAP. Conclusions: Surgical antimicrobial prophylaxis compliance rates are still very low in Turkey. Prolonged duration of SAP and especially high rate of antibiotic prescription at discharge are the main reasons for non-compliance with SAP.

Investigation of stair ascending and descending activities on the lifespan of hip implants.

Total hip arthroplasty (THA) surgeries among young patients are on the increase, so it is crucial to predict the lifespan of hip implants correctly and produce solutions to improve longevity. Current implants are designed and tested against walking conditions to predict the wear rates. However, it would be reasonable to include the additional effects of other daily life activities on wear rates to predict convergent results to clinical outputs. In this study, 14 participants are recruited to perform stair ascending (AS), descending (DS), and walking activities to obtain kinematic and kinetic data for each cycle using marker based Qualisys motion capture (MOCAP) system. AnyBody Modeling System using the Calibrated Anatomical System Technique (CAST) full body marker set are performed Multibody simulations. The 3D generic musculoskeletal model used in this study is a marker-based full-body motion capture model (AMMR,2.3.1 MoCapModel) consisting of the upper extremity and the Twente Lower Extremity Model (TLEM2). The dynamic wear prediction model detailing the intermittent and overall wear rates for CoCr-on-XLPE bearing couple is developed to investigate the wear mechanism under 3D loading for AS, DS, and walking activities over 5 million cycles (Mc) by using finite element modelling technique. The volumetric wear rates of XLPE liner under AS, DS, and walking activities over 5-Mc are predicted as 27.43, 23.22, and 18.84 mm3/Mc respectively. Additionally, the wear rate was predicted by combining stair activities and gait cycles based on the walk-to-stair ratio. By adding the effect of stair activities, the volumetric wear rate of XLPE is predicted as 22.02 mm3/Mc which is equivalent to 19.41% of walking. In conclusion, in this study, the effect of including other daily life activities is demonstrated and evidence is provided by matching them to the clinical data as opposed to simulator test results of implants under ISO 14242 boundary conditions.

Treatment initiation rates of patients with positive anti-hepatitis C virus results in tertiary hospitals in Turkey.

INTRODUCTION: The aim of this national, multicenter, cross-sectional, retrospective chart review study was to determine the proportion of patients in Turkey who received hepatitis C virus (HCV) treatment after receiving positive anti-HCV results during HCV screening. METHODOLOGY: Data related to patients' demographics, laboratory results, time interval from obtaining a positive anti-HCV result to treatment initiation, specialty of the physician requesting anti-HCV screening, and type of hospital were analyzed. RESULTS: Among 1,000 patients who received a positive anti-HCV result, 50.3% were male and 78.5% were screened for HCV-RNA. Among HCV-RNA screened patients, 54.8% (n = 430) had a positive result. Among patients who tested positive for HCV-RNA, 72.8% received HCV treatment in line with their positive anti-HCV results. The median time from obtaining a positive anti-HCV result to initiation of HCV treatment was 91.0 days (interquartile range 42.0 to 178.5). Non-surgical branches requested HCV-RNA testing more frequently than surgical branches (p < 0.001). The rate of access to HCV treatment was higher among patients screened in university hospitals than among patients screened in training and research hospitals (p < 0.001). CONCLUSIONS: Our results indicate a higher rate of treatment initiation among patients with HCV infection than is described in the published literature. Furthermore, the time from screening to treatment initiation was considerably shorter compared with other international studies. However, since HCV-RNA testing was not requested in a significant portion of patients with a positive anti-HCV test result, there might be a large patient population with HCV who do not receive treatment.

Hematological predictors of silent new cerebral ischemic lesions in carotid artery stenting: A retrospective study.

BACKGROUND: Silent new cerebral ischemic lesions (sNCIL) are a common complication of carotid artery stenting (CAS) that can lead to an increase in morbidity and mortality. We aimed to evaluate the impact of hematological parameters on sNCIL in patients undergoing CAS. METHODS: We retrospectively evaluated 103 patients who underwent CAS, with a mean age of 70.5 ± 6.7 years, and 31 (20.1 %) of whom were female. Stents were placed for internal carotid artery revascularization. The presence of new hyperintense lesions on diffusion-weighted imaging (DWI) without neurological symptoms was considered as sNCIL in cases without apparent neurological findings. Patients were categorized into two groups based on DWI results: positive (29) and negative (74). RESULTS: In the study population, sNCIL was observed in 29 patients (28.2 %). The DWI-positive group exhibited significantly higher Plateletcrit (PCT) levels, advanced age, and a lack of embolic protection device usage compared to the DWI-negative group. The Receiver Operating Characteristic (ROC) analysis identified a PCT value of 0.26 as the optimal threshold, detecting the development of sNCIL with a sensitivity of 75.9 % and specificity of 59.1 % (AUC: 0.700; 95 % CI: 0.594-0.806, p = 0.002). CONCLUSION: To be determined by a simple blood parameter, PCT can predict the risk of sNCIL before CAS and holds clinical value in the treatment of patients with carotid artery stenosis.

A single center study of the efficacy and safety of Pro-Glide used for closure in thoracic endovascular aortic repair in patients with previous groin intervention.

BACKGROUND: This study aimed to evaluate the efficacy and safety of Pro-Glide, a suture-mediated vascular closure device, regarding technical success and complications in patients who had undergone aortic intervention and had previous groin intervention (PGI). METHODS: One hundred and thirty-five patients who underwent percutaneous thoracic endovascular aortic repair via the femoral artery and were closed with the Pro-Glide device were analyzed retrospectively. PGI was defined as a history of open surgical access to the femoral artery or wide sheath (>18 F) placement due to endovascular or valvular intervention. The patients were divided into two groups 38 cases with PGI and 97 cases without PGI. RESULTS: The overall success rate of closure of the femoral artery with Pro-Glide was not statistically significant between the two groups (93.8% vs 92.1%, p = .711). Sheath sizes were compared between the groups and PGI (+) group had significantly higher sheath sizes compared to PGI (-) group (24.3 ± 1.1 F vs 23.8 ± 1.0 F, p = .011). Three patients in the PGI (+) group and six patients in the PGI (-) group experienced technical failure of the percutaneous femoral approach. Femoral complications were seen after the procedures in four patients in the PGI (+) group and four in the PGI (-) group. The PGI (+) group had a higher complication rate when compared to the PGI (-) group; however, this was not statistically significant (p = .181). CONCLUSION: The present study was conducted on a significantly larger sample compared to previous studies and the findings suggest that the Pro-Glide vascular closure device is a safe option for patients with a history of PGI and may not be considered as a contraindication.

Gastrointestinal PCR panel results and antibiotic use in acute gastroenteritis cases: How appropriate are we in our usage?

BACKGROUND: We aimed to determine the pathogens detected by the Gastrointestinal (GI) PCR panel in patients with acute gastroenteritis (AGE), the evaluation of antibiotic use in these patients, and the investigation of the role of laboratory parameters in differentiating viral and bacterial etiologies. METHODS: The demographic characteristics, GI PCR panel results, laboratory investigations, antibiotic usage, and appropriateness of antibiotic treatment were investigated in AGE patients. RESULTS: A total of 175 adult patients with AGE and GI PCR panel results were included in the study. The most common pathogens were EPEC (24.6%) and C. difficile (18.3%). Among the 102 patients receiving antibiotic treatment, 34.3% were evaluated as inappropriate antibiotic use. WBC, CRP, procalcitonin, CRP/albumin ratio, and procalcitonin/albumin ratio were found to be significantly higher in cases with bacterial origin. CONCLUSIONS: The utilization of GI PCR panels in AGE patients has revolutionized the field of diagnostics by providing rapid and accurate identification of pathogens. In units without the possibility of GI PCR testing, CRP, procalcitonin, CRP/albumin ratio and procalcitonin/albumin ratio may be useful in the decision of antibiotic treatment.

The prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencing.

The prognosis of patients with advanced HCC can vary widely depending on factors such as the stage of the cancer, the patient's overall health, and treatment regimens. This study aimed to investigate survival outcomes and associated factors in patients with hepatocellular carcinoma (HCC). In this retrospective study, data from 23 medical oncology clinics were analyzed. Progression-free survival (PFS) and overall survival (OS) values were estimated using the Kaplan-Meier method. Prognostic factors associated with survival which were identified in univariate analysis were subsequently evaluated in a multivariate Cox-regression survival analysis was conducted using the backward stepwise (Conditional LR) method to determine the independent predictors of PFS and OS. Of 280 patients, 131 received chemotherapy and 142 received sorafenib, 6 received atezolizumab plus bevacizumab and 1 received nivolumab for first-line setting. The median follow-up time was 30.4 (95%CI 27.1-33.6) months. For-first line, median PFS was 3.1 (95%CI2.7-3.5) months, and it was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab (PFS 5.8 (95%CI 4.2-7.5) than in those received chemotherapy (PFS 2.1 (95%CI 1.9-2.3) in the first-line setting (p < 0.001). Multivariate analysis revealed that male gender (HR: 2.75, 95% CI: 1.53-4.94, p = 0.01), poor ECOG performance score (HR: 1.88, 95% CI: 1.10-3.21, p = 0.02), higher baseline AFP level (HR: 2.38, 95% CI: 1.54-3.67, p < 0.001) and upfront sorafenib treatment (HR,0.38; 95% CI: 0.23-0.62, p < 0.001) were significantly associated with shorter PFS. The median OS was 13.2 (95%CI 11.1-15.2) months. It was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab in the first-line setting followed by TKIs (sorafenib or regorafenib, OS 18.6 (95%CI 13.8-23.5)) compared to those who received chemotherapy (OS 10.3 (95%CI 6.6-14.1)) in the first-line setting. The multivariate analysis revealed that upfront chemotherapy treatment approach, male gender (HR: 1.77, 95% CI: 1.07-2.94, p = 0.02), poor ECOG performance score (HR: 1.96, 95% CI: 1.24-3.09, p = 0.004) and Child-Pugh score, presence of extrahepatic disease (HR: 1.54, 95% CI: 1.09-2.18, p = 0.01), and higher baseline AFP value (HR: 1.50, 95% CI: 1.03-2.19, p = 0.03) were significantly associated with poor prognosis. Additionally, regarding of treatment sequence, upfront sorafenib followed by regorafenib showed a significantly lower risk of mortality (HR: 0.40, 95% CI: 0.25-0.66, p < 0.001). Sorafenib followed by regorafenib treatment was associated with a significantly lower risk of mortality rather than upfront sorafenib followed by BSC group or upfront chemotherapy followed by TKIs. These findings underscore the importance of the optimal treatment sequences to improve survival in patients with advanced HCC.

Association between syndecan-4 and subclinical atherosclerosis in ankylosing spondylitis.

BACKGROUND: Despite advances in the diagnosis and treatment of ankylosing spondylitis (AS), the risk of cardiovascular complications in AS patients is still higher than in the general population. Macrophages are at the intersection of the basic pathogenetic processes of AS and atherosclerosis. Although syndecan-4 (SDC4) mediates a variety of biological processes, the role of SDC4 in macrophage-mediated atherogenesis in AS patients remains unclear. Herein, we aimed to investigate the role of SDC4 in subclinical atherosclerosis in AS patients. METHODS: Subjects were selected from eligible AS patients and control subjects without a prior history of AS who were referred to the rheumatology outpatient clinics. All participants' past medical records and clinical, and demographic characteristics were scanned. In addition, carotid intima-media thickness (CIMT) measurement and disease activity index measurement were applied to all patients. RESULTS: According to our data, serum SDC4 level was significantly higher among AS patients compared with the control group (6.7 [1.5-35.0] ng/mL vs 5.1 [0.1-12.5] ng/mL, P < .001). The calculated CIMT was also significantly higher in AS patients than in the control group (0.6 [0.3-0.9] mm vs 0.4 (0.2-0.7), P < .001]. Additionally, serum C-reactive protein level and SDC4 level were independent predictors of AS and strongly associated with CIMT. Linear regression analysis showed that serum SDC4 level was the best predictor of CIMT (P = .004). CONCLUSION: Our data indicate that serum SDC4 levels provide comprehensive information about the clinical activity of the disease and subclinical atherosclerosis in AS patients.

"Just Because I Don't Conform to Societal Norms": A Qualitative Study of Transgender People's Experiences of Domestic Violence and Coping Methods.

Background Transgender people experience violence in various forms, primarily domestic violence. The aim of this study was to examine transgender people's experiences of domestic violence and their coping methods. Materials and methods This study was conducted using the phenomenological method, one of the five basic qualitative research methods, with 20 transgender participants who applied to Ondokuz Mayis University, Samsun, Turkey, to start the gender-affirming treatment process. The participants comprised 19 transgender men and 1 transgender woman. A semi-structured interview form was used for data collection. The average interview duration was 75.7 minutes. Audio recordings were used in the interviews, which were then transcribed. The obtained data set was subjected to content analysis. Results As a result of the content analysis, three themes emerged: being a transgender individual and the family, experiences of domestic violence, and methods of coping. According to the study results, the participants had experienced domestic violence of different dimensions, primarily psychological violence. Defined gender roles and societal expectations were determined to trigger violent behaviors. The most frequently used coping methods were giving a direct reaction, seeking instrumental-social support, and ignoring the incidents. Conclusion Our findings demonstrated that transgender people experience domestic violence at a high rate and that transphobic behaviors are triggered by societal norms. Our results are particularly noteworthy for clinicians regarding the importance of family support and accurate information for transgender people and the coping methods they use most.