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Giriş ve Amaç: Direkt etkili anti viral ilaçların kullanılmasıyla, hepatit C virüsü enfeksiyonunun tedavisinde başarı oranı %100’e yaklaşmıştır. Bununla birlikte, birçok hasta teşhis konulmayı beklemektedir. Biz mevcut çalışmada cerrahi öncesi hepatit C virüsü taraması yapılan hastalarda anti-hepatit C virüsü ve hepatit C virüs-RNA pozitifliğinin prevalansını belirlemeyi ve hastalığından habersiz olan hastaların oranını araştırmayı amaçladık. Gereç ve Yöntem: 2012-2015 yılları arasında cerrahi kliniklerinde anti-hepatit C virüsü pozitif saptanan hastalar, hepatit C virüs-RNA pozitifliği ve tedavi geçmişi açısından araştırıldı. Hepatit C virüs-RNA pozitifliği açısından hastane kayıtları tarandı. Tedavi bilgilerine Medula Sisteminden (Sosyal Güvenlik Sisteminden entegre bir veri tabanı) ulaşıldı. Tedavisiz anti-hepatit C virüsü pozitif hastalara telefonla pozitiflikten haberdar olup olmadıkları soruldu. Bulgular: 4 yıl boyunca 19627 hasta anti-hepatit C virüsü pozitifliği açısından tarandı. 158 hastada (%0.8) anti-hepatit C virüsü pozitif bulundu (76 erkek, 82 kadın; yaş: 58.2 ± 17.6). Hepatit C virüs-RNA 83 hastada bakılmıştı, 75 hastada hepatit C virüs-RNA testi yoktu. Ulaşılabilen 58 hastanın sadece 14’ü anti-hepatit C virüsü pozitif olduğunu biliyordu. Diğer 44 hasta gastroenteroloji veya enfeksiyon hastalıkları polikliniklerine başvurmaları konusunda uyarıldı. Sonuç: Cerrahi girişim uygulanan 19627 hastanın %0.8’inde anti-hepatit C virüsü genel Türkiye nüfusuna benzer oranda pozitif bulunmuştur. Hastaların neredeyse yarısında hepatit C virüs-RNA test edilmemiş ve çoğu hasta hepatit C virüsü-RNA’nın test edilmesi ve izlenmesi gerektiği bilgisine sahip değildir. Anti- hepatit C virüsünün cerrahi öncesi taranması yeni hastaların tespiti açısından yetersiz bulunmuştur.

Giriş ve Amaç: Nonalkolik steatohepatit nonalkolik yağlı karaciğer hastalığının ilerleyici bir formudur. Nonalkolik steatohepatit, zamanla siroz ve hepatosellüler karsinomaya sebep olabilir. Bu çalışmada nonalkolik yağlı karaciğer hastalığı tanılı olgularda zamanla karaciğer histolojisindeki değişikliklerin araştırılması ve histolojik progresyonla ilişkli klinik ve laboratuvar değişkenlerin saptanması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada 1994-2009 yılları arasında hepatoloji veri tabanına kayıtlı toplam 783 nonalkolik yağlı karaciğer hastalıklı olgu retrospektif olarak tarandı. En az 2 yıl arayla yapılan 2 karaciğer biyopsisi olan 29 hasta çalışmaya alındı. Vücut kitle indeksi, glukoz intoleransı veya diyabetes mellitus varlığı, karaciğer fonksiyon testi dahil biyokimyasal parametreler kaydedildi. Nonalkolik yağlı karaciğer hastalığı aktivite skoru steatoz, lobüler inflamasyon ve hepatosellüler balonlaşma skorlarının toplamı ile hesaplandı. Fibroz skorları ayrı rapor edildi. Bulgular: Ortalama yaş 45.2±11 yıl, olguların 17’si (%58.6) erkekti. Başvuruda ortalama vücut kitle indeksi 29.5±4 kg/m2, 15'i (%51.7) fazla kilolu, 12'si (%41.4) obezdi. Toplam 11’inde (%37.9) diyabetes mellitus, 6’sında (%20.7) glukoz intoleransı vardı. Aspartat aminotransferaz düzeyi ortalama 51±36 IU/ml, alanin aminotransferaz düzeyi ortalama 79±50 IU/ml, albümin ortalama 4.5±0.4 gr/dL, trigliserit ortalama 197±106 mg/dL saptandı. Hastaların 14'ünde (%48.3) “nonalkolik steatohepatit” ve 6’sında (%20.6) basit steatoz vardı. Egzersiz ve diyet önerisiyle kontrol biyopsi için medyan takip aralığı 4.8 yıl (2-9 yıl) saptandı. Kontrol biyopsi anında vücut kitle indeksi ortalama 29.6±4 kg/m2, aspartat aminotransferaz ortalama 38.8±14 IU/ml, alanin aminotransferaz ortalama 59.2±32 IU/ml, 13’ünde (%44.8) diyabetes mellitus ve 7’sinde (%24.1) glukoz intoleransı saptandı. İkinci karaciğer biyopsilerinde nonalkolik yağlı karaciğer hastalığı aktivite skoru; 9 (%31) hastada ilerlemiş, 17’sinde (%58.6) gerilemiş, 3’ünde (%10.3) aynı bulundu. Fibrozis skorunda ise 6 (%20.1) hastada ilerleme, 3 (%10.3) hastada ise iyileşme görüldü. Nonalkolik yağlı karaciğer hastalığı aktivite skoru ilerlemesiyle başlangıç yaşı arasında negatif, başlangıç vücut kitle indeksi ile pozitif korelasyon saptandı, sırasıyla (r=-0.370, p=0.047 ve r=0.485, p=0.007). Fibrozis skoru ilerlemesiyle, başlangıç yaşı arasında negatif, başlangıç vücut kitle indeksi ile pozitif ve kontrol biyopsileri anındaki aspartat aminotransferaz düzeyiyle pozitif korelasyon saptandı, sırasıyla (r=-0.503 p=0.005; r=0.382 p=0.04 ve r=0.546 p=0.007). Sonuç: Basit yağlanma yaşla ve yüksek vücut kitle indeksi ile ilişkili olarak nonalkolik steatohepatite progrese olabilir. Genç yaştakiler, yüksek vücut kitle indeksi ve aspartat aminotransferaz düzeyinde yükseklik olanlar fibrozis progresyonu açısından daha riskli bulunmuştur.

Hepatitis E virus (HEV) infection is estimated to be one of the commonest causes of acute hepatitis in the world. All patients with symptoms consistent with acute hepatitis should be tested for HEV. HEV was thought to be limited to certain developing countries until the last decade and was only ever seen in travellers of developed countries in returning from hyperendemic countries. We now know that HEV could be endemic in most high-income countries and is largely a zoonotic infection. European Association for the Study of the Liver suggests testing for hepatitis E in patients with unexplained flares of chronic liver disease. Particular risk groups for a severe HEV course are pregnant women infected with genotype 1 and older men or patients with underlying chronic diseases for genotype 3. Prevention is the most important point (safe water, avoiding undercooked meat, to be careful in highly endemic countries) to decrease the HEV infection.

Background and aim: Hepatocellular carcinoma (HCC) is one of the most common and most lethal cancers worldwide. The objective of this study was to investigate the relationship between basal parameters and survival characteristics in patients with HCC. Materials and methods: the records of 1447 HCC patients of a tertiary center during the period 2000-2017 were screened retrospectively. The demographic details; basal clinical, laboratory, and radiological characteristics; treatments; and survival time were recorded and prognostic scores were calculated. Results: a total of 788 patients with HCC (male/female: 623/165; mean age: 60.5±10.9 years) were included in the study. The median length of survival was 26.3 months (95% confidence interval [CI], 22.3-30.4 months). The 5-year survival rate was 28.1%. The number and diameter of the tumors; platelet count; platelet-to-lymphocyte ratio; level of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase; portal and hepatic vein involvement; and an alpha-fetoprotein level of, NA

Objectives: Paritaprevir/Ritonavir/Ombitasvir/Dasabuvir (PrOD) seems to be highly effective and safe in chronic haemodialysis (CHD) patients. We presented our experiences of treatment with PrOD in CHD patients.

Liver biopsy is the gold standard method for the diagnosis and treatment of liver diseases. In this study, we aimed to evaluate the results of liver biopsies performed in a year in our clinic. In addition, we also aimed if these liver biopsies could reveal the etiology of liver disease in patients with elevations of transaminases or/and alkaline phosphatase levels or liver masses.Patients who had liver biopsies for persistently elevated transaminases or/and alkaline phosphatase levels, protocol biopsies after liver transplantation, or liver masses in our hepatology clinic between 2011 and 2012 were included in the study. Liver biopsy decisions were made by experts during the hepatology council. Liver biopsies were previously performed using classical percutaneous liver biopsy or ultrasonography-guided SonocanTotally, 479 liver biopsy results (male=252, 52.6%, mean age 49±14.5 years) were evaluated in the study. Of these patients, 432 (male=228) underwent percutaneous liver biopsy and 47 (male=24) underwent SonocanIn this study, diversity in liver biopsy results indicates the importance of histopathological evaluation. The most prevalent pathology in the liver biopsies was chronic hepatitis B, which is the most common chronic liver disease in Turkey. The metastatic liver tumor was the most common among the liver masses.

Background We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH., Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic), A. Gerussi, L. Cristoferi, and P. Invernizzi acknowledge that this research was partially supported by the Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic).

Background Psychometric hepatic encephalopathy score (PHES) needs local standardization. Aims This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE. Methods Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at

Giriş: Çölyak hastalığı(ÇH), glutene maruz kalındığında oluşanbir ince bağırsak hastalığıdır. ÇH, dermatitis herpetiformis, otoimmün tiroidhastalığı, tip 1 diabetes mellitus ve otoimmün karaciğer hastalıkları ilesıklıkla birliktelik gösterir. Otoimmünhepatit (OİH) ve primer biliyer kolanjit (PBK) en sık görülen otoimmünkaraciğer hastalıklarıdır. Bu çalışmada, hastanemizde PBK, OİH ve PBK + OİH overlap tanılı hastalarda ÇH sıklığını araştırdık.Metod: PBK, OİH ve OİH + PBK overlap tanılı hastalar çalışmaya dahil edilmiştir.ÇH tanısıspesifik serum antikorları ve spesifik duodenal biyopsi bulguları ile konulmuştur.Sonuçlar: PBK (n = 47; F:% 95.7; yaş: 53 ± 10 yıl), OİH (n =23; F:% 100; yaş: 48 ± 12 yıl) ve OİH +PBK overlap (n = 29, F:% 96.6, yaş: 51 ± 10.9 yıl) tanılı toplam 99 hasta çalışmaya dahil edilmiştir. PBC grubundaki üç (% 6.4),OİHgrubunda 2 (% 8.7), PBK+OİH overlapgrubunda 1(% 3) hastaya serolojik ve histolojik bulgulara dayanarak ÇHtanısı konuluştur.Tartışma: Tek başınaanti-gliadin antikoru (AGA) pozitifliği veya tek başına anti-endomisyumantikoru (EMA) pozitifliği ÇH tanısıiçin yeterli değildir. Daha kesintanı için, ÇH taramasında her 2 testin birlikte kullanılmasını ve ÇH spesifik antikorların pozitif tespit edildiği olgularda, tanının duodenum biyopsiyle desteklenmesini öneriyoruz., Background:Coeliac disease (CD) is a smallbowel disease, which occurs upon exposure to dietary gluten. CD is oftenassociated with dermatitis herpetiformis, autoimmune thyroid disease, type 1diabetes mellitus and autoimmune liver diseases. Autoimmune hepatitis (AIH) andprimary biliary cholangitis (PBC) are the most common autoimmune liverdiseases. In this study, we investigated the prevalence of CD in patients withPBC, AIH and overlapping PBC + AIH inour Hospital.Methods:Ninety-nine patients with PBC, AIH and overlapping AIH + PBC were included inthis study. Specific serum antibodies and specific duodenal biopsy resultsare used for diagnosis of CD.Results:Ninety-nine patients with PBC (n =47; F: 95.7%; age: 53 ± 10 years), AIH (n = 23; F: 100%; age: 48 ± 12years) and overlapping AIH + PBC (n = 29;F : 96.6%; age: 51 ± 10.9 years) wereincluded in this study.Three patients (6.4%) in the PBC group, one patient (3%)in the PBC + AIH group and two patients (8.7%) in the AIH group wereserologically and histologically diagnosed with CD.Conclusion: Anti-gliadine antibody (AGA) positivity oranti-endomysium antibody (EMA) positivity alone was not sufficient for CDdiagnosis. We suggest using both tests for CD screening to achieve moreaccurate results. In cases of positive CD-specific antibody results, we adviseconfirming the diagnosis by histopathological examination of duodenal biopsies.

Background and Aim: The objective of this study was to evaluate the long-term presence of hepatitis B virus (HBV) DNA in the liver grafts of liver transplant patients who received hepatitis B immunoglobulin (HBIg) plus oral antiviral hepatitis B virus prophylaxis and had negative HBV serum markers. Materials and Methods: Patients aged 18 years or older who underwent liver transplantation for HBV-related liver disease, had negative serum viral markers, and had a liver biopsy at least 3 years after liver transplantation were eligible for this study. Clinical, serological, and pathological data were retrospectively obtained from medical records. The HBV DNA of liver biopsy specimens was assessed using the polymerase chain reaction technique. Results: A total of 150 patients were included. A positive HBV DNA result was seen in 18 (12%) of the liver biopsies. The presence of intrahepatic HBV DNA was not associated with pre-transplantation serum viral markers, type of pre- or post-transplantation antiviral treatment, or post-transplantation immunosuppressive treatment. Conclusion: The findings suggest that while treatment with HBIg plus oral antiviral as post-transplantation HBV prophylaxis may result in a percentage of patients with persistent HBV DNA in the graft, the presence of HBV DNA in the liver graft may not be related to clinical HBV recurrence.

Background: Psychometric hepatic encephalopathy score (PHES) needs standardization for countries and is used for minimal hepatic encephalopathy (mHE) diagnosis. Assessing it is cumbersome.Aims: To standardize PHES for Turkish patients and compare it with German norms; to determine mHE prevalence with two different methods and to assess whether the PHES test can be simplified.Methods: Healthy volunteers (n=816; 400 male) and cirrhotics (n=124; 58 male) were included. PHES score threshold was set at ≤-5 points and that of critical flicker frequency (CFF) at Results: Turkish norms displayed non-linear dependence on age and education. Rate of mHE in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively. Compatibility of two tests was low (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but generally performed better in the other subtests. In ROC analyzes of subtests, AUROC was 0.974 for DS+SD tests combined. Conclusions: PHES norms for Turks were developed. Use of 2 methods for diagnosing mHE may be important for research purposes. From a clinical perspective sensitivity with acceptable specificity may suffice. Combined use of DS and SD subtests of the PHES battery may well be suited for use in clinical practice.

Objective:In hepatitis B infection, it is difficult to make a treatment decision in patients with slightly elevated transaminases and HBV DNA level between 2000 and 20000 IU/ml, and in those with normal ALT, despite high levels of HBV DNA. Objectives: In HBeAg negative patients whose HBV DNA levels were between 2000 and 20000 IU/ml with ALT 1-2 times the upper limit of normal (ULN) and those with HBV DNA >20000 IU/ml and normal ALT, the concordance between liver fibrosis in biopsy and liver stiffness measured by transient elastography with FibroScan®(FS) was investigated, and diagnostic value of FS to predict the liver fibrosis was tested.Methods:The patients were selected from the outpatient hepatology clinics between the dates of November 2014 and October 2016 among those who were taken liver biopsy. Transient elastography was obtained within 3 months after liver biopsy. The diagnostic value of FS in detecting advanced fibrosis or moderate to advanced (MTA) fibrosis was investigated for each group.Results:In 38 patients with HBV DNA 2000-20000 IU/ml and ALT 1-2×ULN, advanced fibrosis was detected in only one patient (2.6%) on liver biopsy, sensitivity of FS to show advanced fibrosis is 100%, specificity 78.3%, and diagnostic accuracy rate 79%. The area under curve was determined to be 0.892. In detecting MTA fibrosis, these values are 100%, 62%, 71%, and 0.810, respectively. Of 79 patients with HBV DNA >20000 IU/ml and normal ALT, five had advanced (5.5%) and 18 had MTA (23%) fibrosis. Sensitivity of FS in detecting advanced fibrosis was 100%, specificity 87.8%, and accuracy 88.6%, and these values for MTA fibrosis were 85.7%, 81%, and 82.3%, respectively.Conclusion:Because of false negativity in a few patients with HBV DNA >20000 IU/ml in detecting MTA, FS may be combined with other non-invasive techniques. Negative predictive values of FS in predicting advanced or MTA fibrosis were very high, while positive predictive values were low. However, FS may save several patients from liver biopsy.Keywords:Fibrosis; HBV; liver biopsy; transient elastography.

105th Annual Meeting of the United-States-and-Canadian-Academy-of-Pathology (USCAP) -- MAR 12-18, 2016 -- Seattle, WA, Hepatocellular carcinomas (HCCs) with steatohepatitis and steatosis are reported with varying definitions and clinicopathologic features. We aimed to search the attributes of steatohepatitic hepatocellular carcinoma (SH-HCC) and steatotic-HCC in our series. A retrospective clinicopathologic analyses of 150 HCCs and immunostaining for C-reactive protein (CRP) and serum amyloid A (SAA) were performed. Tumors were reclassified as all SH-HCC, limited SH-HCC, typical SH-HCC (steatohepatitic features in >5%, 5% to 50%, and >= 50% of the tumor, respectively), steatotic-HCC, and classic HCC (C-HCC). Group comparisons were made using Kruskal-Wallis and Kaplan-Meier tests. The background etiology in all SH-HCCs was pure viral in 51.4%, nonalcoholic steatohepatitis (NASH)/alcoholic liver disease (ALD) alone/mixed in 34.3%, and unidentified in normal liver in 14.3%. All SH-HCCS (n=35, 23.3%) and typical SH-HCCs (n=13, 8.6%) had higher NASH/ALD. Limited SH-HCCs (n=22, 14.6%) had higher ALD (all P0.05). SH-HCC is heterogenous in terms of underlying etiologies, and can be seen in NASH/ALD, pure viral and noncirrhotic/normal background. The >= 50% cutoff for the definition of SH-HCC can lead to overlook ALD-related SH-HCC. Steatotic-HCC seems more similar to C-HCC rather than SH-HCC, but none of them feature as a different prognostic group., US & Canadian Acad Pathol, Ege University Scientific Research Projects Fund [2.101.2014.0071], Supported by Ege University Scientific Research Projects Fund (Project No: 2.101.2014.0071). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Background and Aim: Hepatitis E virus (HEV) may cause chronic liver disease in solid organ transplant recipients. We determined HEV seroprevalence and associated factors in liver transplant recipients. Materials and Methods: Patients followed at the outpatient clinic of liver transplantation between January 2019 and January 2020 were screened retrospectively for HEV serology (HEV immunoglobulin M [IgM] and HEV immunoglobulin G [IgG]). Results: Of the 150 patients (male/female, 104/46; age, 55.4 +/- 13.2 years), anti-HEV IgG was positive in 31 (20.7%), and anti-HEV IgM was negative in all. The mean time after liver transplantation (72 [48%] deceased and 78 [52%] living donors) was 81 +/- 78.5 months. Drinking water consisted of carboy and tap water in 88 (58.7%) and 62 patients (41.3%), respectively. Of the patients, 120 (80%) and 30 (20%) lived in urban and rural areas, respectively. On comparison, the difference between positive and negative anti-HEV IgG groups in terms of age, place of birth, water supply, and donor type was statistically significant (p=0.007, p=0.000, p=0.034, and p=0.049, respectively). Conclusion: HEV seroprevalence was more frequent in liver transplant recipients compared with the normal population. Older age, water supply, and place of birth were risk factors for HEV seroprevalence.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel acute infectious disease that has rapidly reached staggering pandemic proportions. This review addresses gastroenterologists, hepatologists, liver transplant (LT) specialists, and health-care professionals working in the field of liver diseases and liver transplantation. It has been writ ten based on a limited number of publications, recommendations of national and international liver and organ transplantation societies, and experiences of patients with COVID-19 around the world. The purpose of this review is to provide information addressing questions and concerns about COVID-19, to reveal the effects of the novel disease on patients with chronic liver disease and LT recipients, and to share information about ways in which this pandemic will affect clinical practices. We, the Turkish Association for the Study of the Liver (TASL), would like to remind you that this text is actually not a practical guide. It is imperative to act according to the standards set by health-care institutions and the Ministry of Health, Republic of Turkey.

Background/Aims: Despite surgical advances in liver transplantation and effective prophylactic strategies, posttransplant infections are the most important cause of morbidity and mortality. Diagnosis and management of infections because of developing immunosuppression is difficult and adversely affects mortality. This study aimed to review bacterial and fungal infections in patients after liver transplantation and to reveal the resistance rates. Materials and Methods: A total of 107 patients who underwent liver transplantation between January 2017 and February 2018 were evaluated retrospectively with regard to demographic characteristics, causes of transplantation, conditions that may lead to infection, postoperative infections, pathogens, and resistance patterns. Results: of the 107 patients who underwent liver transplantation, 48 (44.8%) had an infection. Bacterial infections were detected in 41% of the patients, and fungal infections were found in 13%. When we compared living and cadaveric transplants in terms of infection development, these rates were found to be 53% and 33%, respectively (p=0.034). No statistically significant results could be obtained when evaluating conditions such as sex, presence of underlying primary disease, Model for End-Stage Liver Disease MELD score, diabetes status, total parenteral nutrition, and risk factors for infection. Conclusion: After liver transplantation, infections are often seen in the first month of the postoperative period. Knowing the most common pathogens and resistance states in this process reduces infection-related deaths by providing appropriate treatment regimens at the right time., Infect Dis & Clin Microbiol Special Soc Turkey

Background/Aims: Ledipasvir (LDV) and sofosbuvir (SOF) as single-tablet regimen (STR) has been approved for treatment of chronic HCV infection (CHC) for treatment-naive or experienced cirrhotic or non-cirrhotic patients. Our aim was to analyse the effectiveness and safety of 12-24 weeks treatment of LDV/SOF (90mg/400 mg)+/- ribavirin in a real-life setting in Turkey. Materials and Methods: Between May-Dec 2016, 104 treatment-naive or experienced adult patients with CHC and with or without cirrhosis (including decompensated cirrhosis) were included in this observational study. Patients were administered LDV/SOF STR +/- ribavirin once daily for 12-24 weeks. SVR12 rates and effects of the baseline characteristics on SVR12 rates were assessed. Results: Out of 104 enrolled patients (61.5% female, mean age 62.0 years); 60.6% were cirrhotic, 76.0% previously used peg-IFN, 94.2% had GT1. At the end of the treatment, 77.8% (77/99, no data for 21 patients) had undetectable HCV-RNA and 98.9% (94/95) had SVR12. in the baseline characteristics subgroups, the SVR12 rates varied between 94.4% and 100%, and none of the baseline characteristics had a significant effect on the SVR12 rates. During the study, 6 (5.8%) patients died and none of the deaths was suspected to be related to the LDV/SOF. No treatment-emergent adverse event was reported. Conclusion: in conclusion, LDV/SOF +/- ribavirin yielded very high SVR12 rates, without any safety or tolerability concern in Turkey. the effectiveness of the LDV/SOF treatment was not affected by the patient demographics or medical characteristics such as fibrosis level, cirrhosis status, previous treatment status, HCV-RNA level or HCV genotype., Gilead Sciences, TurkeyGilead Sciences, This study was supported by Gilead Sciences, Turkey for editorial support in the preparation of this manuscript.

WOS: 000449010500007, PubMed ID: 30381274, Background/Aims: Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. Materials and Methods: Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). Results: A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring, the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally established. Conclusion: LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.

The present guideline updates the Turkish recommendations for the screening, diagnosis and management of Hepatitis C virus (HCV) infection prepared by the Turkish Association for the Study of the Liver (TASL) and Viral Hepatitis Society (VHS). The aim of this guidance was to provide updates recommendations to physicians, who are interested in HCV care on the optimal screening, diagnosis and pre-treatment management for patients with HCV infection in Turkey. These recommendations, produced by panel experts, were aimed to addresses the management issues ranging from diagnosis and linkage to care, to the optimal treatment regimen in patients with HCV infection. Recommendations are based on evidence and opinions of more than 70% of the panelists. This guidance is supported by the memberships of two societies and not by pharmaceutical companies. This guidance will be updated frequently as new data become available.

Background/aims This study aimed to compare the causes of nonvariceal upper gastrointestinal bleeding (NVUGB), demographics, risk factors, and outcomes of patients during two periods between 1993 and 2016 in a tertiary health-care center in Turkey. Materials and methods We compared the causes of NVUGB and clinical outcomes in 421 patients hospitalized between January 1993 and December 1995 with those of 231 patients with NVUGB hospitalized between January 2015 and September 2016. We also compared epidemiological characteristics, risk factors, and the rates of endoscopic hemostatic procedures. Results We observed significant increases in patients' mean age, in the percentage of patients with comorbid conditions, and in the percentage of patients who received direct-acting oral anticoagulants before bleeding. We also observed a statistically nonsignificant increase in the diagnoses of gastric ulcer, along with a significant concordant decrease in diagnoses of duodenal ulcer as a cause of bleeding. The use of emergency surgical hemostasis decreased among cases of peptic ulcer bleeding. The overall rate of mortality from bleeding did not significantly change between the two periods. Conclusion Over the 23 years studied, the causes of NVUGB changed, probably because the population was increasingly elderly population and because of the use of anticoagulants and better therapeutic approaches to chronic duodenal ulcers. The use of emergency surgical hemostasis reduced, but mortality rate did not significantly change between the two specific periods.

INTRODUCTION:Crosstalk between hepatocytes and immune cells is the key point that ultimately leads to inflammation and fibrosis. This is well-known entity underlying the decompansation of liver failure. Recently, it has been shown that the ratio of lymphocyte to monocytes that can be measured easily in peripheral blood reflects many inflammatory processes. In this study, we aimed to find the novel inflammatory parameters predicting subclinical hepatic encephalopathy in patients with liver failure who were routinely followed up in outpatient clinics.METHODS:Seventy-six cirrhotic patients who were followed up in Ege University Medical Faculty Hospital Gastroenterology-Hepatology out-patient clinic were included in the study. Thirteen similar healthy volunteers in terms of age and gender were also recruited. We applied psychometric hepatic encephalopathy score (PHES) and Critical flicker frequency test (CFF) for both patient groups (with and without covert hepatic encephalopathy (CHE)). We analyzed neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), mean platelet volume as well as INR, CRP, albumin, total bilirubines and platelet counts from routine clinic testing samples, retrospectively.RESULTS:According to West-Haven criteria, CHE was detected in 41 patients and not detected in 35 patients. When CFF test was applied, patients with CHE completed by reacting late compared to non-CHE patients (pCONCLUSION:LMR and NLR, which are cheap and easily available hemogram parameters, can provide early warning to clinicians for cirrhotic patients in outpatient follow-up.

EgeUn###, INTRODUCTION: Risk stratification based on biochemical variables is a useful tool for monitoring ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC). Several UDCA response criteria and scoring systems have been proposed for risk prediction in PBC, but these have not been validated in large external cohorts. METHODS: We performed a study on data of 1746 UDCA-treated patients with PBC from 25 centers in Europe, United States, and Canada. The prognostic performance of the risk scoring systems (GLOBE and UK-PBC) and the UDCA response criteria (Barcelona, Paris I, Paris II, Rotterdam, and Toronto) were evaluated. We regarded cirrhosis-related complications (ascites, variceal bleeding, and/or hepatic encephalopathy) as clinical end points. RESULTS: A total of 171 patients reached a clinical end point during a median 7 years (range 1-16 years) of follow-up. The 5-, 10- and 15-year adverse outcome-free survivals were 95%, 85%, and 77%. The GLOBE and UK-PBC scores predicted cirrhosis-related complications better than the UDCA response criteria. The hazard ratio (HR) for a 1 standard deviation increase was HR 5.05 (95% confidence interval (CI): 4.43-5.74, P < 0.001) for the GLOBE score and HR 3.39 (95% CI: 3.10-3.72, P < 0.001) for the UK-PBC score. Overall, the GLOBE and UK-PBC risk scores showed similar and excellent prognostic performance (C-statistic, 0.93; 95% CI: 0.91%-95% vs 0.94; 95% CI: 0.91%-0.96%). DISCUSSION: In our international, multicenter PBC cohort, the GLOBE and UK-PBC risk scoring systems were good predictors of future cirrhosis-related complications.

WOS: 000481718800005, PubMed ID: 31418413, Background/Aims: The Social Security System of our country reimburses only paritaprevir, ritonavir, ombitasvir, and dasabuvir (PrOD) regime in treatment-naive patients with hepatitis C regardless of kidney disease. Most of our renal transplant (RT) recipients were treated with PrOD. The aim of the present study was to investigate the efficacy and safety of PrOD in RT patients with hepatitis C virus (HCV) infection in a single center real-life experience. Materials and Methods: RT recipients with a post-transplant follow-up of at least 1 year were included in the study. The patients were treated and monitored according to the guidelines. Blood levels of immunosuppressive patients were closely followed up and adjusted. Results: A total of 21 (12 male and nine female) patients were assessed. The age of the patients was 50.8 +/- 8.5 years. Ten patients were infected with G1a, 10 patients with G1b, and one patient with G4 HCV. Two patients had compensated cirrhosis. Eighteen patients were treatment-naive, and three were peginterferon+ribavirin-experienced. Sustained virologic response (SVR12) was achieved in all patients. None of the patients discontinued the treatment. Cyclosporine (Csa) and tacrolimus (Tac) doses were reduced to once a day to once a week to maintain the blood level within normal range. The most common adverse effect was anemia in patients receiving ribavirin. Renal functions did not change during the treatment period. Conclusion: In this real-life experience, all of the 21 PrOD-treated RT recipients reached SVR12. Tac or Csa serum levels were maintained within the normal range with close monitoring. PrOD regime can be successfully and safely used in RT recipients with HCV infection with close follow-up.

Background and study aims: Liver fibrosis score is associated with peripheral platelet count in patients with chronic hepatitis B (CHB). Lamivudine therapy decreases the liver fibrosis score in these patients. The aim of this study was to evaluate the relationship between increasing peripheral platelet count and decreasing liver fibrosis scores in patients with CHB on lamivudine therapy. Patients and methods: One hundred and fifty-three patients with CHB who received at least 2-years of lamivudine therapy in a tertiary care center were enrolled in the study. Patients with splenomegaly and/or bi- or pancytopenia were excluded. Liver biopsy had been performed prior to and at the end of the second year of the lamivudine therapy. Lamivudine-induced alterations of aspartate aminotransferase, alanine aminotransferase levels, fibrosis score, and peripheral platelet count were compared with Wilcoxon test. A p-value of less than 0.05 was regarded as significant. Results: Of 153 patients, 99 (64.7%) were male and mean age (± SD) was 39.05 ± 11.8 years. HBeAg was found to be positive in 71 (46.4%) patients. Lamivudine decreased aspartate aminotransferase, alanine aminotransferase levels, fibrosis score, and increased peripheral platelet count. Increased peripheral platelet count showed a significant correlation with decreased alanine aminotransferase levels (p 0.05). Conclusions: Increased peripheral platelet count during the lamivudine therapy is not related decreased liver fibrosis score in patients with CHB.

The recently reported benefit of telbivudine for renal function has not been systematically studied in long-term liver transplantation (LT) recipients who are at high risk for renal impairment. We aimed to examine whether switching lamivudine therapy to telbivudine could improve renal function in LT recipients who have impaired renal function. This single-center, prospective cohort study enrolled LT recipients who were on lamivudine for hepatitis B virus (HBV) prophylaxis and who had renal impairment for at least 1 year. Lamivudine was switched to telbivudine. The primary outcome was to evaluate the change in renal function at weeks 12, 24, 36, and 48. The secondary outcomes were to assess the efficacy of telbivudine for HBV prophylaxis and the safety profile of telbivudine in the posttransplant setting. After 45 patients were enrolled, the study was terminated early because of increased rates of polyneuropathy/myopathy. During telbivudine treatment (median, 64 weeks), estimated glomerular filtration rate (eGFR) increased in 34 patients (76%). The improvement in renal function was prominent after 24 weeks of telbivudine treatment. Telbivudine was effective as prophylaxis against HBV recurrence. Twenty-six patients (58%) developed polyneuropathy and/or myopathy. The 1-year estimated incidence of polyneuropathy/myopathy was 28%. Diabetes was the strongest predictor of polyneuropathy/myopathy (hazard ratio, 4.13; 95% confidence interval, 1.49-11.50; P = 0.007). In conclusion, although it seems to have a favorable effect in the improvement of renal function and seems to be effective in the prevention of HBV recurrence, the high risk of polyneuropathy and myopathy hampers the use of telbivudine in LT recipients. Liver Transpl 21:1066-1075, 2015. © 2015 AASLD.

We aimed to measure the diurnal changes of critical flicker frequency in healthy subjects and cirrhotic patients and to investigate their relationship with sleep disturbance.Cirrhotic patients and healthy volunteers were included. All groups completed the Pittsburgh Sleep Quality Index and a simple sleep questionnaire. Sleep disturbance was defined as a Pittsburgh Sleep Quality Index score of5. Critical flicker frequency was measured twice a day to detect diurnal abnormalities.Overall, 59 cirrhotic patients (54.2% males, Mean Age 59 ± 11 years) and 18 controls (39.9% males, Mean Age 58 ± 9 years) were included. Sleep disturbances were more common in cirrhotics (66.1%) than controls (38.9%, p0.05). In cirrhotics, the critical flicker frequency was not related to decompensation. The nocturnal values were higher than the morning values in cirrhotics (64.4%), but not in controls (p0.0001). Additionally, sleep disturbances were more common in cirrhotics who had higher nocturnal values (p0.05).Changes in the diurnal critical flicker frequency were observed in cirrhotics but not in controls. Sleep disturbances in cirrhotics appear to be associated with deviations of the diurnal rhythm of critical flicker frequency rather than with clinical parameters such as the clinical stages of cirrhosis and the Model For End-Stage Liver Disease and Child-Pugh scores.

Hepatocellular carcinoma is the most common primary liver malignancy. Liver transplantation has been a successful therapy for selected patients with hepatocellular carcinoma. Since 1996, Milan criteria have been universally recognized as the guidelines for selecting patients with hepatocellular carcinoma for orthotopic liver transplantation. However, the simple use of tumor size and number has been insufficient to indicate the biologic features of hepatocellular carcinoma and to predict the risk of tumor recurrence. The Milan criteria are quite strict because their rules can cause patients to be excluded from wait lists who could in fact benefit from transplant. Therefore, many expanded criteria are now incorporating different biologic markers, such as alpha-fetoprotein. 18F-fluorodeoxyglucose positron emission tomography-computed tomography could be a helpful diagnostic tool to decide the most suitable therapy, particularly for patients with hepatocellular carcinoma beyond the Milan criteria. Patients initially beyond Milan criteria can be downstaged to reduce tumor size to fulfill Milan criteria. Locoregional therapies are used for downstaging, including transarterial chemoembolization, radiofrequency ablation, and percutaneous ethanol injection. Good responses to downstaging therapy and then waiting at least 3 months after locoregional therapy to reevaluate the decision of liver transplantation for patients with hepatocellular carcinoma beyond Milan criteria can result in better survival rates in these patients. Sorafenib and mammalian target of rapamycin inhibitors are promising agents for reducing tumor recurrence rate after liver transplantation. With cautious patient selection criteria and the use of locoregional therapy before liver transplantation, good results can be obtained for patients beyond Milan criteria who had no better chance other than liver transplant.

WOS: 000415165200027, PubMed ID: 28603052, BACKGROUND & AIMS: Predniso(lo) ne, alone or in combination with azathioprine, is the standard-of-care (SOC) therapy for autoimmune hepatitis (AIH). However, the SOC therapy is poorly tolerated or does not control disease activity in up to 20% of patients. We assessed the efficacy of mycophenolate mofetil (MMF) and tacrolimus as second-line therapy for patients with AIH. METHODS: We performed a retrospective study of data (from 19 centers in Europe, the United States, Canada, and China) from 201 patients with AIH who received second-line therapy (121 received MMF and 80 received tacrolimus), for a median of 62 months (range, 6-190 mo). Patients were categorized according to their response to SOC. Patients in group 1 (n = 108) had a complete response to the SOC, but were switched to second-line therapy as a result of side effects of predniso(lo) ne or azathioprine, whereas patients in group 2 (n = 93) had not responded to SOC. RESULTS: There was no significant difference in the proportion of patients with a complete response to MMF (69.4%) vs tacrolimus (72.5%) (P = .639). In group 1, MMF and tacrolimus maintained a biochemical remission in 91.9% and 94.1% of patients, respectively (P = .682). Significantly more group 2 patients given tacrolimus compared with MMF had a complete response (56.5% vs 34%, respectively; P = .029) There were similar proportions of liver-related deaths or liver transplantation among patients given MMF (13.2%) vs tacrolimus (10.3%) (log-rank, P = .472). Ten patients receiving MMF (8.3%) and 10 patients receiving tacrolimus (12.5%) developed side effects that required therapy withdrawal. CONCLUSIONS: Long-term therapy with MMF or tacrolimus generally was well tolerated by patients with AIH. The agents were equally effective in previous complete responders who did not tolerate SOC therapy. Tacrolimus led to a complete response in a greater proportion of previous nonresponder patients compared with MMF.

Hepatitis delta virus (HDV) is a defective RNA virus that depends on hepatitis B virus (HBV) for its lifecycle. Treatment of chronic HDV infection is difficult as it does not have an enzymatic function as a target, such as polymerases and proteases of HBV and hepatitis C virus. Recently, it has been suggested that farnesyl transferase could be an enzymatic target. Currently, interferon is the only agent against HDV infection. Virological response has risen to 20-47% with pegylated interferon. Monotherapy of nucleos(t)ide analogs are ineffective against the HDV infection, but adefovir and pegylated interferon combination therapy have had some advantages for reduction of HBV surface antigen (HBsAg) levels. Recent studies suggest that measuring HBsAg levels during treatment could be more meaningful than HDV RNA negativity to predict virological response. Prenylation inhibitors that can affect the interactions between the large HDV antigen and HBsAg in the HDV virion are expected treatments for HDV infection. More studies are needed to understand the molecular mechanisms of HDV to manage the disease.

Objective: There is a lack of data concerning Turkish patients with alcoholic hepatitis (AH). The aims of the present study were to present the clinical characteristics of hospitalized AH patients and to compare the predictive ability of Maddrey’s discriminant function (DF) score, Model for End-Stage Liver Disease (MELD) score, Glasgow AH (GAHS) score and age, bilirubin, International Normalized Ratio (INR), and creatinine (ABIC) score on in-hospital mortality. Methods: The DF score and clinical data of 34 patients with AH admitted from 2008 to 2014 were reviewed from patient’s files. Scores for MELD, GAHS and ABIC were then retrospectively calculated. A comparison of scores was obtained using area under the receiver operating characteristics curves to predict in-hospital mortality. Results: In-hospital mortality was calculated at 23.5% (8/34). Treatment with corticosteroids and/or pentoxifylline was started in 18 patients with DF score ≥ 32; however, seven of them died (7/18, 39%). No significant differences were found between DF, MELD, GAHS and ABIC scores for predicting in-hospital mortality (p>0.05). Conclusion: DF score, which is easier and more practical, can be used in clinical practice to predict in-hospital mortality because other scores have no statistical superiority. The response to corticosteroid and/or pentoxifylline treatment in patients with a DF score ≥ 32 was poor in Turkish AH patients.

Myasthenia gravis is an antibody-mediated autoimmune disease at the neuromuscular junctions. It can be associated with many other autoimmune diseases. We report a case of acute presentation of autoimmune hepatitis with myasthenia gravis, thymoma, Hashimoto thyroiditis and connective tissue disorder.

AIM To investigate the macrophage migration inhibitory factor (MIF) expression and -173 G/C polymorphism of the MIF gene in nonalcoholic fatty liver disease (NAFLD). METHOD Ninety-one patients with diagnosis of NAFLD and 104 healthy controls were included in the study. MIF -173 G/C polymorphism was detected using the PCR-restriction fragment length polymorphism based method. NAFLD was stratified as nonalcoholic steatohepatitis (NASH), probable NASH and steatosis, respectively in groups 1, 2 and 3, according to NAFLD Activity Score. MIF expression was detected by immunohistochemistry staining. RESULTS Mean age of the patients was 50.1+/-9.6 years, and 54 of them were male. Serum alanine aminotransferase and aspartate aminotransferase were 50/83, 42/63 and 31/32, respectively in groups 1, 2 and 3, (P

Background: Non-alcoholic fatty liver disease (NAFLD) is common in obese and diabetics. Serine protease inhibitor Kazal-1 (SPINK-1) protein is highly expressed in the liver and adipose tissue of diabetic and obese suggesting its role in NAFLD. SPINK-1 also behaves as an acute phase reactant protein. Some genetic factors including the genetic variations in SPINK-1 protein have been linked to chronic pancreatitis and diabetes. We therefore hypothesized that SPINK-1 mutations might be a risk factor for the development of NAFLD. Methods: Liver biopsy proven fifty NAFLD cases (20 steatohepatitis, 30 diffuse fatty liver disease and 44 healthy controls were included to the study. Liver function tests were measured. Body mass index was calculated. Insulin resistance was determined by using a homeostasis model assessment (HOMA-IR). Ultrasound evaluation was performed for each subject. Common genetic mutations in the third exon of SPINK-1 gene were analyzed by direct sequencing method. Results: We found two cases with a SNP at N34S location in NAFLD group (allele frequency %4). One subject with diffuse fatty liver disease and other with liver cirrhosis due to NAFLD had N34S mutation. No SNPs were detected in healthy controls. In conclusions, in limited number of patients SPINK-1 mutations were not considered as a risk factor alone for NAFLD development.

Summary Background Pretransplantation clearance of hepatitis C virus (HCV)-RNA reduces the risk of HCV recurrence after transplantation. Furthermore, a sustained virological response could reduce disease progression and slow clinical deterioration in nontransplanted patients. Aim To evaluate the safety, tolerability and efficacy of pegylated-interferon (PEG-IFN) alfa-2a plus ribavirin therapy in HCV-related decompensated cirrhotics. Methods Twenty HCV-related decompensated cirrhotics (44–67 years, 12 males, six Child–Pugh score A, 14 Child–Pugh score B, all with genotype 1b) were enrolled into the study. Treatment with PEG-IFN alfa-2a (135 μg, once a week) plus ribavirin (1000–1200 mg/day) was commenced. A 48-week treatment was planned in patients who had early virological response. Results Treatment was stopped in 8 (40%) patients. The remaining 12 (60%) patients completed 48 weeks of therapy; nine (45%) of them obtained end-of-therapy virological response and six (30%) of them obtained sustained virological response. Living donor liver transplantation was performed in three (15%) patients. Eight (40%) and six (30%) patients needed to reduce PEG-IFN alfa-2a and ribavirin dosages, respectively. No patient died during the follow-up period. Conclusion PEG-IFN alfa-2a plus ribavirin therapy is safe, tolerable and efficacious in selected HCV-related decompensated cirrhotics.

Background: Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and a defect in antibody production. Herein we describe 3 patients diagnosed with CVID in whom vitamin D deficiency was detected in the absence of enteropathy. Methods: Biochemical and immunological analysis, serum osteocalcin, parathyroid hormone, 25-OH vitamin D, 1,25(OH)2 vitamin D, vitamin A, vitamin E, urinary calcium, and deoxypyridinoline measurements were carried out. Vitamin D receptor (VDR) expression was examined in the peripheral blood mononuclear cells and hair follicles by reverse transcriptase polymerase chain reaction. VDR gene polymorphism was evaluated by high-performance liquid chromatography. Results: None of the patients presented nutrient deficiencies other than vitamin D. Two of them were free of osteomalacia-related symptoms. VDR expression was found to be lower in the peripheral blood mononuclear cells and hair follicles when compared to the control group. Conclusions: Patients with CVID may present asymptomatic vitamin D deficiency. Vitamin D and VDRs play an important role in the innate immune system and modulate Toll-like receptor-related responses. Delay in diagnosis may predispose these patients not only to irreparable bone loss but also to infections, and autoimmune and malignant disorders, thus emphasizing the importance of prompt intervention.

We studied clinical and laboratory effects of 3 months of lamivudine with adefovir combination and adefovir dipivoxil (AD) alone in the treatment of patients with lamivudine-resistant hepatitis B virus (HBV) infection. Eligible patients were hepatitis B surface antigen-positive men and women with compensated liver disease who were given lamivudine at least more than 6 months and had HBV polymerase gene mutation. Patients were assigned to receive adefovir 10 mg/day (Group 1) or adefovir 10 mg once daily and lamivudine 100 mg once daily combination during first 3 months, and then stopped lamivudine and continued adefovir (Group 2). Median age was 48 years (34 males and 20 females, and 35 were HBeAg-negative). Baseline median ALT, AST, and HBV DNA levels were 66 IU/l, 49 IU/l, and 6.7 log(10) copy/ml, respectively. Median adefovir therapy time and ALT normalization time were 9 and 3.5 months, respectively. There was no significant difference between groups according to the baseline HBV DNA, ALT, HBe Ag status, age, gender, and lamivudine resistance time. Virological and biochemical responses were similar in both groups during therapy. Two patients (8%) had ALT flare more than five times upper limit of normal without any clinical decompensation in Group 1. Mild ALT elevation according to baseline levels were found in 8 (27.6%) and 4 (17.4%) patients, respectively, in Group 2 and Group 1, and no statistically significance between two groups. In conclusion, this study showed that it is not necessary to continue lamivudine therapy while switching to AD therapy. Adefovir alone is effective in the treatment of patients with lamivudine resistant HBV infection and compensated liver disease, without significant clinical and laboratory flares. However, it is not easy to say that switching to AD with cessation of lamivudine is safe, because the study population is not enough for precise conclusion and resistance may be a considerable problem against AD in patients using long-term treatment.

SUMMARY Background and Aim The potential prognostic value for survival of nutritional status in cirrhotics after adjusting Child–Pugh classification and Model for End-Stage Liver Disease has not been evaluated. Methods We used Kaplan–Meier and Cox proportional hazards regression models to identify factors associated with mortality in a cohort of 222 cirrhotics [M/F:145/77 median age 52 (18–68) years] with prospectively collected nutritional parameters as well as modified subjective global nutritional assessment, Royal Free Hospital-Subjective Global Assessment index. Follow-up was censored at the time of transplantation. Other variables were ones in Child–Pugh and Model for End-Stage Liver Disease scores, age, aetiology of cirrhosis and renal function, Results Pretransplant mortality (Kaplan–Meier) was 21% by 2 years (135 patients were transplanted). Among the nutritional parameters, only Royal Free Hospital-Subjective Global Assessment remained significantly associated with mortality in multivariable models (P = 0.0006). The final model included the following variables: urea (P = 0.0001), Royal Free Hospital-Subjective Global Assessment (P = 0.003), age (P = 0.0001), Child–Pugh grade (P = 0.009) and prothrombin time (P = 0.003). The results were similar when the Child–Pugh grade was replaced by the Model for End-Stage Liver Disease score in the model, and whether a competing risks model was used. Conclusions Nutritional indices add significantly to both Child–Pugh grade and Model for End-Stage Liver Disease scores when assessing the patient prognosis.

Anti-HBs immunoglobulins (HBIG) and lamivudine are main options to prevent hepatitis B virus (HBV) reinfection after liver transplantation. Although they are very effective, development of mutant viruses and high cost of treatment are main limitations for their application. Additionally there is an uncertainity for the duration of that prophylaxis regimen and its mostly applied indefinitely. Recently, post-transplant HBV vaccination is reported to be a cheaper alternative prophylaksis strategy, that enables discontinuation of HBIG. To investigate the efficacy of HBV vaccination in patients transplanted for HBV cirrhosis, we administered double course of double dose recombinant HBV vaccine (Genhavac B; containing HBV pre-S1, pre-S2, and S gene products). Vaccination has been started 1 month after HBIg discontinuation, and lamivudine (100 mg/day) was given throughout the study. The first cycle consisted of 0, 1- and 6-month schedule, and, in nonresponders, second cycle 0, 1-, 2-month schedule. Fourteen patients included into the study. Only one patient seroconverted (an anti-HBs titre of 37 IU/L) after the first cycle. No other patient responded to second cycle. HBV vaccination in the post-transplantation setting does not seems like an effective strategy in the prophylaxis of HBV recurrence.

Primary biliary cirrhosis (PBC) is an immune-mediated chronic cholestatic disease characterized by the presence of antibodies directed predominantly against the E2 subunit of the pyruvate dehydrogenase complex (PDC-E2). What provokes tolerance breakdown in PBC remains to be established, though there is evidence to indicate that microbes may induce anti-mitochondrial antibodies (AMA) through a mechanism of molecular mimicry.Having found that urease beta (UREB)(22-36) antigen of Helicobacter pylori (HELPY) shares extensive (87%) similarity with PDC-E2(212-226), the major mitochondrial autoepitope, it was hypothesized that this would also lead to cross-reactivity. The UREB/PDC-E2 mimics were thus constructed and tested by ELISA in 112 PBC patients and 114 controls.Reactivity to PDC-E2(212-226) was found in 104 patients but to UREB(22-36) in only 2. In these two patients, the double reactivity was not cross-reactive. The lack of surface antibody accessibility to UREB(22-36), as demonstrated through three-dimensional model prediction analysis, may explain this unexpected finding. There was some speculation on whether HELPY UREB(22-36) might act as a cross-reactive CD4 T-cell epitope. All seven PBC patients, tested in a standard proliferation assay against PDC-E2(212-226), gave a positive response. All seven were unresponsive to HELPY UREB(22-36). The pattern of reactivity to HELPY antigens by immunoblot was similar between anti-PDC-E2-positive and negative PBC cases, as well as between PBC patients and controls.Contrary to common belief, extensive sequence homology (molecular mimicry) between self and microbe does not necessarily result in cross-reactivity. It is therefore likely that, when present, cross-reactivity between self and microbes is of biological importance.

Background Bile duct stones are still present in 10% to 15% of patients after the application of conventional endoscopic extraction techniques and require additional procedures for duct clearance. In the vast majority of these cases, there are 2 main problems: large stone size (>15 mm) and tapering of distal bile duct. Methods : Fifty-eight patients in whom endoscopic sphincterotomy and standard basket/balloon extraction were unsuccessful in the removal of bile duct stones underwent dilation with a 10- to 20-mm diameter (esophageal/pyloric type) balloon at the same session. In 18 patients with tapered distal bile ducts (Group 1), 12-to 18-mm diameter balloon catheters were used to enlarge the orifice. In 40 patients with square, barrel shaped and/or large (>15mm) stones (Group 2), the sphincterotomy orifice was enlarged with 15-to 20-mm diameter balloon catheters. After dilatation, standard basket/balloon extraction techniques were used to remove the stone(s). Results : Stone clearance was successful in 16 patients (89%) in Group 1 and 35 (95%) in Group 2. Complications occurred in 9 (15.5%) patients. Conclusion : Dilation with a large-diameter balloon after endoscopic sphincterotomy is a useful alternative technique in patients with bile duct stones that are difficult to remove with standard methods.

Although hypo- and hyperthyroid patients have different symptoms in the gastrointestinal tract, the mechanism of thyroid action on the gut remains poorly understood. Thus the aim of this study was to investigate the effect of hypo- and hyperthyroidism on gastric myoelectrical activity, gastric emptying, dyspeptic symptoms. Twenty-two hyperthyroid (median age 45, 15 females) and 11 hypothyroid (median age 42, 10 females) patients were included into the study. Dyspepsia score, hypo- and hyperthyroid symptom scale, abdominal ultrasonography and upper gastrointestinal endoscopy were performed. Gastric myoelectrical activity was measured by electrogastrograpy (EGG) before and after therapy both preprandially and postprandially and compared with age, gender, and body-matched controls (12 for hypothyroid, 15 for hyperthyroid patients). Radionuclide gastric emptying studies were performed with a solid meal. Hypothyroid patients revealed a significant increase in preprandial tachygastria as compared with controls (12.3% vs 4.8%). The percentage of preprandial normal slow waves (2.4–3.7 cpm) was below 70% (dysmotility) in 7 of 11 hypothyroid patients versus 2 of 12 controls (P < 0.05). Hyperthyroid patients revealed a significantly higher preprandial (3.1 vs 2.8) and postprandial (3.4 vs 3) DF when compared with the controls (P < 0.05). A higher percentage of postprandial taschygastria (7.9 vs 0) was present in hyperthyroid patients than in the controls (P < 0.05). The decrease on postprandial EGG power (power ratio < 1) was observed in 7 patients the in hyperthyroid group and 1 in controls (P < 0.05). The percentage of postprandial normal slow waves was below 70% in 10 of 20 hyperthyroid patients vs 1 of 15 controls (P < 0.05). After therapy these differences disappeared in the euthyroid state. The hypo- and hyperthyroid symptom scale correlated to dyspepsia score. Dyspepsia score in hyperthyroidism correlated to power ratios in hyperthyroid patients. We detected some correlations between serum levels of fT3 or fT4 and some EGG parameters in hypo- and hyperthyroidism. Dyspepsia score and hypo- and hyperthyroid symptom scale were improved significantly after therapy in the euthyroid state. In conclusions, we showed gastric dysrhythmia by EGG in both hypo- and hyperthyroid patients. Dyspeptic symptoms correlated to the activity of thyroid disease. After therapy, these findings and dyspeptic symptoms improved in the euthyroid state. Abnormalities of power ratios may be responsible of dyspeptic symptoms in hyperthyroid patients. EGG may be a useful and noninvasive tool for detecting gastric disturbances during hypo- and hyperthyroidism.

The aim of this study was to determine the long-term efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) on the natural course of disease in chronic hepatitis B patients (CHB) with/without cirrhosis in clinical practice. A total of 355 treatment-naive CHB patients were enrolled into the study. The primary outcome measure was viral suppression as defined by serum HBV DNA level

We hereby present the case of a 75 years old female who was complaining of right upper quadrant abdominal pain. She had a history of cystectomy, cholecystectomy and choledochotomy operations for liver hydatid cyst 5 years ago. In addition, multiple endoscopic retrograde cholangiopancreatography sessions had been performed for recurrent biliary duct stones in the last 4 years. Radiological investigations revealed the presence of cirrhosis and the herniation of the left liver lobe through the abdominal incisional hernia defect. Secondary sclerosing cholangitis as a result of the previous operations was suggested to be the probable etiology for cirrhosis. The cirrhotic patient with an advanced age was found to be high risk for surgery. In addition, her symptoms were minimal. Thus, she was managed conservatively. Herniation of the liver is very rare. It is quite difficult to speculate any predisposing risk factors for liver herniation because of the rarity of this condition.

Girifl ve Amac: Bu cal›flman›n amac›, bolgemizde, hepatit C virusu infeksiyonunun olas› bulafl›m yollar›n›n ve yak›n donemde he- patit C virusu genotiplerinin da¤›l›m›n›n belirlenmesidir. Gerec ve Yontem: Hepatit C virusu risklerinin belirlenmesi amac› ile Ege Universitesi Hastanesi T›bbi Mikrobiyoloji Laboratuvar›na, 2005-2010 tarihleri aras›nda kan ornekleri yollanarak anti-hepatit C virus pozitif olarak bulunan toplam 215 hasta cal›flmaya al›nm›flt›r. Hepatit C virusu genotip belirleme cal›flmas› icin Mart 2007- Mart 2011 tarihleri aras›nda ayn› laboratuvara baflvuran 535 hasta ornei cal›flmaya al›nm›flt›r. Hepatit C virusu bulafl›nda ola- s› risk faktorleri hakk›nda bilgi, telefon anketi ile toplanm›flt›r. Hepatit C virusu genotiplemesi icin restriksiyon parca uzunluu po- limorfizmi analizi yap›lm›flt›r. Bulgular: Cal›flma grubunda en s›k gorulen risk faktorlerinin dental giriflimler (171; %79,5) ve ameliyat oykusu (137; %63,7) olduu belirlendi. 535 hastan›n 499'unda (%93.3) genotip 1 saptand›. Genotip 1 saptanan olgular›n 69'unun genotip 1a (%12,9), 430'unun (80,4%) 1b subtipi olduu belirlendi. Genotip 3, 20 hastada (%3,7), genotip 2, sekiz hastada (%1,5) ve genotip 4, sekiz hastada (%1,5 ) saptand›. Sonuc: Genotip 1 d›fl› olgularda bir art›fl olmakla beraber bolgemizde genoti- pik ceflitlilik nadir olarak izlenmektedir. Hastanemize baflvuran hastalarda hepatit C virus infeksiyonu ac›s›ndan risk faktorleri- nin bafl›nda dental giriflimler ve ameliyat oykusu bulunmaktad›r. Bu risk faktorleri basit infeksiyon kontrol uygulamalar› ve ei- tim programlar› ile onlenebilir niteliktedir. Anahtar kelimeler: Genotip, hepatit C, risk faktorleri Background/aims: The aim of this study was to investigate the risk factors which may be involved in the transmission of hepati- tis C virus and to determine the recent distribution of various genotypes in Western Turkey. Materials and Methods: The risk de- termination study consisted of 215 patients whose serum samples were sent to the Medical Microbiology Laboratory at Ege Univer- sity Hospital between 2005 and 2010 and were anti-hepatitis C virus positive. For the determination of recent genotype distributi- on, genotyping results of all 535 patients sent to the same laboratory from 2007 to 2011 were analyzed. Information on possible risk factors for the transmission of hepatitis C virus was obtained by a telephone questionnaire. Hepatitis C virus typing was performed by restriction fragment length polymorphism analysis. Results: The most frequently reported risk factors were history of dental pro- cedures in 171 (79,5%) patients and surgical operations in 137 (63,7%) patients. Genotype 1 was observed in 499 of the 535 patients (93,3%) with chronic hepatitis C virus infection. Of these, 69 patients showed infection with subtype 1a (12.9.%) and 430 - with subt- ype 1b (80.4%). Genotype 3 was determined in 20 patients (3,7%), genotype 2 - in 8 patients (1,5), and genotype 4 - in 8 patients (1,5%). Conclusions: Even though there is an increase in non-1 genotypes, Turkish patients with chronic hepatitis C still represent a rather homogenous group with genotypic diversity encountered rarely. The risk factors detected in the patients admitted to our hospital are mainly medical procedures which can be prevented by the use of simple infection control practices and implementati- on of an education program.