Assuntos
Bezoares/cirurgia , Corpos Estranhos/cirurgia , Obstrução da Saída Gástrica/cirurgia , Gastroscopia , Estômago/cirurgia , Bezoares/complicações , Feminino , Corpos Estranhos/complicações , Obstrução da Saída Gástrica/diagnóstico , Obstrução da Saída Gástrica/etiologia , Humanos , Pessoa de Meia-Idade , Sementes/efeitos adversos , Zea mays/efeitos adversosAssuntos
Candida/isolamento & purificação , Candidíase/diagnóstico , Doenças do Esôfago/etiologia , Doenças Retais/etiologia , Reto/patologia , Idoso , Candidíase/tratamento farmacológico , Colite Ulcerativa , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Doenças do Esôfago/tratamento farmacológico , Doenças do Esôfago/microbiologia , Feminino , Fluconazol/uso terapêutico , Humanos , Imunocompetência , Doenças Retais/tratamento farmacológico , Doenças Retais/microbiologia , Úlcera/tratamento farmacológico , Úlcera/etiologiaRESUMO
AIM: There are common findings between Behçet's disease (BD) and celiac disease (CD) based on similar immunological pathogenesis and there is only limited data available investigating the link between these two diseases. Furthermore, documented gastrointestinal (GI) involvement with marked upper GI symptoms in BD has been rarely reported. The aim of this study was to assess the prevalence of CD and to evaluate endoscopic findings in Turkish BD patients. METHODS: A total of 210 BD patients were included in the study. All patients underwent serological testing for anti-gliadin and tissue transglutaminase antibodies. Endoscopic examinations were performed in 190 patients who accepted upper GI system endoscopy. Multiple biopsies were taken from the second portion of the duodenum in patients with positive serological assessment for CD. RESULTS: A total of 4.2% of patients with BD had positive anti-gliadin and tissue transglutaminase antibody immunoglobulin A (IgA) and IgG antibodies. The prevalence of biopsy-confirmed CD was 1.05% in Turkish BD patients. The most common endoscopic findings of patients with BD were found to be antral gastritis, duodenitis and esophagitis. CONCLUSION: Although BD and CD share many similar clinical manifestations, our results did not support a possible association between these two diseases.
Assuntos
Síndrome de Behçet/epidemiologia , Doença Celíaca/epidemiologia , Adolescente , Adulto , Idoso , Autoanticorpos/sangue , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/imunologia , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/imunologia , Criança , Duodenite/epidemiologia , Duodeno/patologia , Endoscopia Gastrointestinal , Esofagite/epidemiologia , Feminino , Proteínas de Ligação ao GTP/imunologia , Gastrite/epidemiologia , Gliadina/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Proteína 2 Glutamina gama-Glutamiltransferase , Testes Sorológicos , Transglutaminases/imunologia , Turquia/epidemiologia , Adulto JovemAssuntos
Colite/diagnóstico , Colite/etiologia , Colonoscopia/efeitos adversos , Fosfatos/efeitos adversos , Doença Aguda , Colite/tratamento farmacológico , Colonoscopia/métodos , Enema/efeitos adversos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Fosfatos/administração & dosagem , Medição de Risco , Índice de Gravidade de Doença , Irrigação Terapêutica/efeitos adversos , Resultado do TratamentoRESUMO
PURPOSE: We aimed to determine dual-energy computed tomography (DECT) characteristics of colorectal cancer and investigate effectiveness of DECT method in differentiating tumor from stool in patients with colorectal cancer. METHODS: Fifty consecutive patients with colorectal tumors were enrolled. Staging was performed by DECT (80-140 kV) using dual-source CT after rectal air insufflation and without bowel preparation. Both visual and quantitative analyses were performed at 80 kV and 140 kV, on iodine map and virtual noncontrast (VNC) images. RESULTS: All colorectal tumors had homogeneous pattern on iodine map. Stools demonstrated heterogeneous pattern in 86% (43/50) and homogeneous pattern in 14% (7/50) on iodine maps and were less visible on VNC images. Median density of tumors was 54 HU (18-100 HU) on iodine map and 28 HU (11-56 HU) on VNC images. Median density of stool was 36.5 HU (8-165 HU) on iodine map and -135.5 HU (-438 HU to -13 HU) on VNC images. The density of stools was significantly lower than tumors on both iodine map and VNC images (P < 0.001). The cutoff point of density measurement on VNC images was -1 HU with area under the curve of 1 and a sensitivity and specificity of 100%. CONCLUSION: Density or visual analysis of iodine map and VNC DECT images allow accurate differentiation of tumor from stool.
Assuntos
Neoplasias Colorretais/diagnóstico por imagem , Fezes , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/métodos , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Reto/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeAssuntos
Pólipos Adenomatosos/induzido quimicamente , Pólipos Adenomatosos/diagnóstico , Anticonvulsivantes/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Carbamazepina/efeitos adversos , Neoplasias Gástricas/induzido quimicamente , Neoplasias Gástricas/diagnóstico , Ácido Valproico/efeitos adversos , Pólipos Adenomatosos/terapia , Anticonvulsivantes/administração & dosagem , Carbamazepina/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Gástricas/terapia , Ácido Valproico/administração & dosagemRESUMO
Toll-like receptors (TLRs) may play an important role in hepatitis-B pathogenesis. However, serum TLR-2 and TLR-4 levels and their association with serum liver enzymes, hepatitis B virus (HBV) DNA, quantitative HBsAg levels, and liver biopsy findings, are unknown. A total of naive 40 HBeAg (-) chronic hepatitis B (CHB) patients and 20 healthy control subjects were recruited in this study. Liver tests, HBV DNA, serum TLR-2 and TLR-4, and quantitative HBsAg levels were evaluated among all groups. The relationship among TLR-2, TLR-4, quantitative HBsAg levels and liver tests, and liver histological findings were investigated with correlation analysis. Serum TLR-2 and TLR-4 levels in HBeAg (-) CHB patients were higher than in the control group. There was a positive correlation between serum TLR-2, TLR-4, and HBV DNA and ALT levels. We have further demonstrated that serum TLR-2 levels are correlated with AST and quantitative HBsAg levels. However, TLRs levels were not linked to the liver biopsy findings. TLR can have an important role in hepatitis B pathogenesis. Liver injury in CHB may cause elevated TLR-2 and TLR-4 levels.
Assuntos
Antígenos E da Hepatite B/sangue , Hepatite B Crônica/imunologia , Soro/química , Receptor 2 Toll-Like/análise , Receptor 4 Toll-Like/análise , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , Biópsia , DNA Viral/sangue , Feminino , Antígenos de Superfície da Hepatite B/sangue , Histocitoquímica , Humanos , Fígado/enzimologia , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Antivirais/uso terapêutico , Sulfonamidas/uso terapêutico , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Acessibilidade aos Serviços de Saúde , Imidazóis/uso terapêutico , Isoquinolinas/uso terapêutico , Antivirais/economia , Antivirais/efeitos adversos , Sulfonamidas/economia , Sulfonamidas/efeitos adversos , Fatores de Tempo , Turquia , RNA Viral/genética , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento , Custos de Medicamentos , Análise Custo-Benefício , Hepacivirus/genética , Carga Viral , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Hepatite C Crônica/virologia , Quimioterapia Combinada , Genótipo , Acessibilidade aos Serviços de Saúde/economia , Imidazóis/economia , Imidazóis/efeitos adversos , Isoquinolinas/economia , Isoquinolinas/efeitos adversosRESUMO
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.
Assuntos
Antivirais/uso terapêutico , Acessibilidade aos Serviços de Saúde , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Imidazóis/uso terapêutico , Isoquinolinas/uso terapêutico , Sulfonamidas/uso terapêutico , Idoso , Antivirais/efeitos adversos , Antivirais/economia , Carbamatos , Análise Custo-Benefício , Custos de Medicamentos , Quimioterapia Combinada , Feminino , Genótipo , Acessibilidade aos Serviços de Saúde/economia , Hepacivirus/genética , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Hepatite C Crônica/virologia , Humanos , Imidazóis/efeitos adversos , Imidazóis/economia , Isoquinolinas/efeitos adversos , Isoquinolinas/economia , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Pirrolidinas , RNA Viral/genética , Sulfonamidas/efeitos adversos , Sulfonamidas/economia , Fatores de Tempo , Resultado do Tratamento , Turquia , Valina/análogos & derivados , Carga ViralAssuntos
Colite Ulcerativa/microbiologia , Listeriose/complicações , Colite Ulcerativa/líquido cefalorraquidiano , Colite Ulcerativa/psicologia , Confusão/líquido cefalorraquidiano , Confusão/microbiologia , Feminino , Febre/líquido cefalorraquidiano , Febre/microbiologia , Febre/psicologia , Cefaleia/líquido cefalorraquidiano , Cefaleia/microbiologia , Cefaleia/psicologia , Humanos , Listeriose/psicologia , Pessoa de Meia-IdadeAssuntos
Pólipos/patologia , Pólipos/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Biópsia por Agulha , Feminino , Seguimentos , Gastroscopia/métodos , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Pólipos/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Resultado do TratamentoAssuntos
Carcinoma Neuroendócrino/patologia , Linite Plástica/patologia , Neoplasias Gástricas/patologia , Biomarcadores Tumorais/análise , Biópsia , Carcinoma Neuroendócrino/química , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/cirurgia , Feminino , Gastrectomia , Gastroscopia , Humanos , Imuno-Histoquímica , Linite Plástica/química , Linite Plástica/diagnóstico por imagem , Linite Plástica/cirurgia , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Gástricas/química , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND & AIMS: Direct-acting antiviral agents have improved treatment outcomes for patients with hepatitis C virus (HCV) infection; however, head-to-head comparisons are limited. The C-EDGE Head-2-Head Study compared the safety and efficacy of elbasvir/grazoprevir (EBR/GZR) with sofosbuvir plus pegylated interferon/ribavirin (SOF/PR) in patients with HCV infection. METHODS: This was a randomized, open-label, phase III trial. Two hundred fifty-seven patients with HCV genotype (GT)1 or 4 infection and baseline viral load >10,000IU/ml were randomized to receive 12weeks of EBR/GZR 50mg/100mg once daily (n=129) or sofosbuvir (400mg once daily) plus PR (n=128). Primary efficacy objective was sustained virologic response 12weeks after the end of therapy (SVR12, HCV RNA <15IU/ml). The primary safety objective was the proportion of patients experiencing a tier 1 safety event. RESULTS: The majority of patients were non-cirrhotic (83.1%), treatment-naïve (74.9%) and had HCV GT1b infection (82.0%). SVR12 rates were 99.2% (128/129) and 90.5% (114/126) in the EBR/GZR and SOF/PR groups, respectively. The estimated adjusted difference in SVR12 was 8.8% (95% confidence interval [CI], 3.6-15.3%). Because the lower bound of the 1-sided 1-sample exact test was greater than -10% and greater than zero, both non-inferiority and superiority of EBR/GZR vs. SOF/PR were established. The frequency of tier 1 safety events was lower among patients receiving EBR/GZR than SOF/PR (0.8% vs. 27.8%, between group difference, 27.0% [95% CI, -35.5% to -19.6%; p<0.001]). CONCLUSIONS: EBR/GZR has a superior efficacy and safety profile in patients with HCV GT1 or 4 infection compared with SOF/PR. LAY SUMMARY: The combination of elbasvir/grazoprevir for 12weeks was highly effective in treating patients with chronic hepatitis C, genotypes 1 or 4 infection. This regimen was more effective than sofosbuvir/pegylated interferon/ribavirin for 12weeks, and was notably superior in patients regarded as difficult to treat, including those with previous treatment failure, cirrhosis, or a high baseline viral load. The combination of elbasvir/grazoprevir also demonstrated a superior safety and tolerability profile based on fewer serious adverse events, no serious drug-related adverse events, and no treatment discontinuations. CLINICAL TRIAL REGISTRATION: Clinical trials.gov Identifier: NCT02358044.