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Objectives: Patients with chronic hepatitis C virus (HCV) infectionand superinfection by hepatitis A or hepatitis B virus have highermorbidity and mortality when compared with those without HCVinfection. The aim of this study was to determine hepatitis A and Bseroprevalence rates and immunity in patients with chronic HCV indifferent regions of TurkeyMaterials and Methods: This multi-center study involving HCVinfected chronic cases was conducted between July 2016 andOctober 2017. Serological tests of Hepatitis B surface antigen, antiHBs, hepatitis B core antibody (anti-HBc) immunoglobulin G (IgG)and anti-HAV IgG were evaluated by ELISA, and the files of HCVinfected patients at the age of 18 or over who applied to 15 hospitalsin 13 different cities of our country were screened.Results: Three hundred sixty-two of the 828 patients were menand 466 were women. The prevalence of HBV/HCV coinfection was2.4%, while the anti-HBs positivity rate was 46.9%. Of the 610patients evaluated in terms of anti-HAV IgG serology, 88.8% wereanti-HAV IgG positive, while 11.1% were anti-HAV IgG negative.Isolated anti-HBc IgG positivity was detected in 5.8% of patients.Conclusion: Revealing the serological status of other hepatitisagents, such as hepatitis A and B, in patients with chronic hepatitisC is important in terms of providing the opportunity to immunize ortreat when required Gereç ve Yöntemler: HCV ile enfekte kronik olguları içeren çok merkezli bu çalışma Temmuz 2016-Ekim 2017 tarihleri arasında yapıldı. Hepatit B yüzey antijeni (HBsAg, antiHBs, antiHBcIgG ve antiHAVIgG’nin serolojik testleri ELISA ve 18 yaşında HCV ile enfekte hastaların dosyaları veya Ülkemizin 13 farklı ilinde 15 hastaneye başvuranlar tarandı. Ülkemizin 13 farklı ilindeki 15 hastanenin HCV ile enfekte hastalarının dosyaları tarandı ve ELISA yöntemi ile değerlendirilen HBsAg, anti-HBs, anti-HBc IgG ve antiHAV IgG bakıldı. Bulgular: Sekiz yüz yirmi sekiz hastanın üç yüz altmış ikisi erkek, 466 kadındı. HBV/HCV koenfeksiyon prevalansı %2,4 iken antiHBs pozitiflik oranı %46,9 idi. Anti-HAV IgG serolojisi açısından değerlendirilen 610 hastanın %88,8’i anti-HAV IgG pozitif, %11,1’i anti-HAV IgG negatif idi. Hastaların %5,8’inde izole anti-HBc IgG pozitifliği saptandı. Sonuç: Kronik hepatit C’li hastalarda hepatit A ve B gibi diğer hepatit ajanlarının serolojik durumunun ortaya konması, gerektiğinde aşılama veya tedavi fırsatı sağlama açısından önemlidir WOS:000605350300005

Background/aims Hepatitis C virus (HCV) infection is a common disease that causes liver cirrhosis, hepatocellular carcinoma, and extra hepatic manifestations with high mortality and morbidity rates. This study aimed to present real-life experiences and results of treatment of HCV infection with direct-acting antiviral agents (DAAs) from the Euro-Asian region, including Turkey and Azerbaijan. Materials and methods A total of 1224 patients with chronic HCV infection were treated with DAAs in accordance with the international guidelines for the management of HCV infection. The mean age was 58.74±14.75 years, with 713 (58.25%) females. The genotypes of the patients were as follows: genotype 1b, 83.36% (n=1024); genotype 1a, 8.08% (n=99); genotype 2, 2.85% (n=35); genotype 3, 3.34% (n=41); genotype 4, 1.71% (n=21); and combined genotypes, 0.32% (n=4). Approximately 808 patients were treated with sofosbuvir-based DAAs with or without Ribavirin for 12 or 24 weeks, whereas 416 patients were treated with the Paritaprevir, Ombitasvir, Ritonavir.Dasabuvir (PROD) regimen with or without Ribavirin for 12 weeks or 24 weeks. Results At the end of follow-up examinations, 1183 patients (97.93%) had sustained virological response (SVR), 17 (1.40%) died of reasons unrelated to the treatment regimen, 12 had recurrence after treatment, and 129 (10.67%) had adverse events like anemia, itching, and weakness. Conclusion In this large cohort of HCV-infected patients, treatment with DAAs yielded a high overall SVR rate of 97.93%. DAAs were safe and well-tolerated. Thus, the elimination of HCV infection is no longer a dream worldwide.

This article is on the optimum design of driver seats in commercial vehicles, which are expected to provide high comfort to drivers during long travel distances. This comfort is usually achieved through a pneumatic actuation and suspension motion that provides alignment with the road. Moreover, the seat which directly hosts the driver is supposed to ensure safety and best working conditions. The result is that seat weight increases considerably when all comfort, safety, and reliability features are incorporated. But, weight is an important factor in automotive transportation as it results in increased cost and also undesired emission values. For this reason, even the smallest reduction in the weight of commercial vehicles can lead to high amounts of savings. In this study, weight reduction and structural strengthening are targeted together with the help of topography optimization. Optimizations were made, and in these studies, the desired lightness and target strength levels were achieved. As a result of the study, optimization, weight reduction, strengthening, product performance, production cost and material cost outputs were considered and remodeled for better quality. An ECE R14 seat belt pulling test was simulated as an ultimate solution, and the expected results were obtained yet again. With the help of optimization and simulation tools, the appropriateness of the outcomes was assessed at the end of the study and found to achieve a 7 % reduction in weight and 13 mm displacement improvement.

Introduction and aims Hepatocellular carcinoma (HCC) is a consequence of chronic liver disease, particularly from hepatitis B or C and increasingly from obesity and metabolic syndrome. Since lipids are an important component of cell membranes and are involved in cell signaling and tumor cell growth, we wished to evaluate the relationship between HCC patient plasma lipids and maximum tumor diameter and other indices of HCC human biology. Methods We examined prospectively-collected data from a multi-institutional collaborative Turkish HCC working group, from predominantly HBV-based patients, for plasma lipid profiles, consisting of triglycerides, total cholesterol, LDL-cholesterol (LDL) and HDL-cholesterol (HDL) and compared these with the associated patient maximum tumor diameter (MTD), portal vein thrombosis, alpha-fetoprotein (AFP) and also with patient survival. Results We found that both low HDL (p=0.0002) and high LDL (p=0.003) levels were significantly associated with increased MTD, as well as in a final multiple linear regression model on MTD. The combination of low HDL combined with high HDL levels were significant in a regression model on MTD, PVT and an HCC Aggressiveness Index (Odds Ratio 12.91 compared to an Odds Ratio of 1 for the reference). Furthermore, in a Cox regression model on death, the HDL plus LDL combination had a significantly higher Hazard Ratio than the reference category. Conclusions Low plasma HDL, high plasma LDL and especially the combination, were significantly related to more aggressive HCC phenotype and the combination was significantly related to a higher Hazard Ratio for death.

Background and aim Hepatocellular carcinoma (HCC) biomarkers are limited, as even the best studied, alpha-fetoprotein (AFP), is elevated in no more than 50% of HCC patients. The aim was to evaluate several serum liver function tests in relation to survival and tumor characteristics in a large cohort of Turkish HCC patients. Methods We retrospectively examined the serum levels of gamma glutamyl transpeptidase (GGT) in relation to patient survival. Results Kaplan-Meier analysis showed that only GGT and albumin amongst liver function tests, were significantly associated with survival. Survival worsened with increase in GGT levels semi-quantitatively. Increase in GGT levels was also found to significantly correlate with an increase in maximum tumor diameter from 4.5 to 7 cm, a 20-fold increase in serum alpha-fetoprotein level, an increase in tumor multifocality from 20 to 54% of patients, and a doubling in percent of patients with portal vein thrombosis (PVT) from 20 to 40%. Serum GGT levels also showed significant survival differences for patients with low AFP levels. A doublet combination of serum GGT with albumin levels was associated with higher hazard ratios in a Cox regression analysis, as compared with single parameter GGT. The combination parameter pair was also prognostically useful in the low-AFP patient subcohort and was associated with significant differences in patient tumor characteristics. Conclusions Serum GGT levels and especially combination serum GGT plus albumin levels, were significantly associated both with HCC patient survival and tumor aggressiveness characteristics, regardless of AFP levels in a large Turkish cohort. This might be especially useful since the majority of HCC patients do not have elevated levels of AFP.

Introduction Hepatocellular carcinoma is associated with several chronic inflammatory conditions. It is increasingly understood that the inflammation may be part of the carcinogenic process and prognostically important. Objective To evaluate the serum levels of three inflammation markers in relation to survival in HCC patients. Methods We retrospectively examined the serum levels of CRP, albumin and ESR, both singly and in combination, in relation to patient survival. Results Survival worsened with increase in CRP or ESR or decrease in albumin levels. Combinations of CRP plus albumin or CRP plus ESR were associated with an even greater range of survival (3-fold), together with significant differences in maximum tumor diameter (PVT) and percent of patients with portal vein thrombosis (PVT). The triplet of CRP plus albumin plus ESR was associated with a sevenfold difference in survival, comparing low vs high parameter levels. These significant differences were found in patients with small or large tumors. Conclusions Combinations of CRP with albumin or ESR or all three parameters together significantly related to differences in survival and to differences in MTD and percent PVT, in patients with both small and large size HCCs.

Objectives: To evaluate the histopathological changes in the liver after oral antiviral therapy in patients with chronic hepatitis B. Methods : A total of 79 HBeAg-negative and positive patients who had been on lamivudine, entecavir, or tenofovir disoproxil for at least 3 years prior to inclusion were enrolled between March 2015 and 2016, retrospectively. There were 23 patients on lamivudine, 21 patients on entecavir, and 35 on tenofovir. All patients underwent a follow-up liver biopsy. Biochemical, serological, virological and histopathological data were recorded in all patients and were compared after at least 3 years of treatment with oral antiviral agents. Results : Histological activity index scores were reduced in patients who received lamivudine ( p =0.011), entecavir ( p =0.002), and tenofovir ( p =0.001). Also, in contrast with a significant improvement in fibrosis scores in lamivudine ( p =0.033) and tenofovir ( p =0.001) groups no improvements were found in patients who received entecavir ( p =0.090). Conclusion : Long term treatment with oral antiviral agents was associated with biochemical, virological, serological, and histopathological improvements. Long-term use of anti-viral agents as well as continuous suppression of HBV DNA are prerequisites for histopathological improvement. Saudi Med J 2018; Vol. 39 (10): 999-1005 doi: 10.15537/smj.2018.10.23056 How to cite this article: Sahin A, Namiduru M, Balkan A, Karaoglan I, Gulsen MT. Assessment of histopathological alterations in patients with chronic hepatitis B infection following long-term oral antiviral therapy. Saudi Med J . 2018 Oct;39(10):999-1005. doi: 10.15537/smj.2018.10.23056.

Background and study aims Apoptosis represents a well-known mechanism of cell death involved in most chronic liver injuries. Our aim was to investigate the serum fragment level of cytokeratin 18 (CK18), M30, in asymptomatic hepatitis B virus (HBV) carriers and patients with chronic hepatitis B (CHB) and to evaluate the relationship between serum M30 levels and the severity of hepatic injury. Patients and methods Asymptomatic HBV carriers (n = 169), patients with CHB (n = 100), and healthy control subjects (n = 43) were enrolled in the study. Serum CK18 (M30) levels were analysed in all subjects. Liver biopsy for histopathological assessment was performed in asymptomatic HBV carriers and in patients with CHB infection. Results Serum CK18 (M30) levels were significantly higher in asymptomatic HBV carriers (198.77 ± 77.62 U/L) than in healthy control subjects (146.92 ± 40.18 U/L). Patients with CHB (283.02 ± 147.45 U/L) had significantly higher CK18 (M30) levels than asymptomatic HBV carriers ( p = 0.001). The diagnostic efficacy of CK18 (M30) levels in distinguishing patients with HBeAg-negative CHB from asymptomatic HBV carriers was found to be moderate (c-statistics: 0.695), and the diagnostic cut-off value of CK18 (M30) was 262 U/L (specificity: 85%, sensitivity: 48%, positive likelihood ratio: 3.35, and negative likelihood ratio: 0.60). There was a positive correlation between serum CK18 (M30) levels and histological activity index scores in asymptomatic HBV carriers and patients with CHB. Conclusions Serum CK18 (M30) levels may be a valuable indicator in distinguishing asymptomatic HBV carriers from patients with HBeAg-negative CHB when considered together with ALT and HBV-DNA levels.

Extrahepatic cholangiocarcinoma (ECC) is an aggressive malignancy causing a lot of fatalities and comorbidities. Endoscopic biliary stenting (EBS) is mostly needed for ECC. In this study, we aimed to investigate the prognostic factors for the overall survival (OS) and the factors predicting the patients eligible for chemotherapy after EBS in ECC. We retrospectively screened 153 advanced ECC patients who underwent EBS for jaundice to make the patients eligible for chemotherapy. Patient's clinical and laboratory parameters were recorded. OS was estimated by the Kaplan–Meier method. All parameters were assessed by binary logistic regression analysis to predict which patients are eligible for chemotherapy. The median OS of all patients was 12.0 months (10.1–13.8). The median OS of the patients treated with chemotherapy was 13.0 months (12.0–14.0), while it was 4.0 months (2.3–5.7) for patients unable for chemotherapy after EBS. Albumin, aspartate aminotransferase (ALT) and carbohydrate antigen 19-9 (CA 19-9) values were independent prognostic factors for OS. Higher albumin and lower prothrombin time (PT) levels were independent parameters to predict the patients eligible for chemotherapy after EBS. Being suitable for chemotherapy was the main determinant for prolonged survival and albumin and PT levels were independent predictors for chemotherapy eligibility after EBS. Albumin, ALT, and CA 19-9 values were independent prognostic factors for OS in ECC.

Background: In this study, it was aimed to evaluate the relationship between the severity of necroinflammation in the liver and the stage of fibrosis and the serum levels of Serum Prolidase Activity (SPA) and Cytokeratin (CK)-18 in patients with active Chronic Hepatitis B (CHB) and asymptomatic Hepatitis B Virus (HBV) carriers. Methods: Biochemical analyses, serological parameters associated with HBV and serum prolidase activity and CK-18 levels were measured in asymptomatic HBV carriers (n=65), active CHB patients (n=60) and healthy controls (n=27). Liver biopsies were performed on asymptomatic HBV carriers and active CHB patients. Findings: SPA level was significantly higher in active CHB patients (819.92 ± 123.74 IU/L) compared to asymptomatic HBV carriers (732.99 ± 124.70 IU/L) and was higher in asymptomatic HBV carriers compared to healthy controls (529.4 ± 74.73 IU/L) (p=0.001). The diagnostic cut-off value of SPA level was found 751.15 U/L. When this cut-off value was taken to differentiate HBe-Ag negative CHB in asymptomatic HBV carriers, sensitivity and specificity of efficacy were 72% and 63% respectively (c-statistics: 0.707). A strong positive correlation was observed between serum prolidase level and the severity of fibrosis in asymptomatic HBV carriers (r=0.603, p=0.000). A positive correlation was determined between SPA level and Histological Activity Index (HAI) scores in patients with active CHB and asymptomatic HBV carriers. The serum CK-18 levels were significantly lower in the healthy control group when compared to the asymptomatic HBV carriers and active CHB patients (p=0.001). Conclusion: Prolidase enzyme may be beneficial in differentiating asymptomatic HBV carriers from HBeAg-negative CHB patients when used in combination with ALT and HBV-DNA levels.

Background & Aims: Both unsedated transoral endoscopy (TOE) and sedated TOE have some drawbacks in clinical practice. Unsedated transnasal endoscopy (TNE) has been suggested as an alternative to both methods. This study aimed to determine the advantages of TNE in patients who have previously undergone unsedated conventional TOE.Methods: Patients who had received an unsedated TOE in the last 12 months and were scheduled for a second upper endoscopy were included. They were randomized to undergo either unsedated TOE, using a standard endoscope, or unsedated TNE, using an ultrathin endoscope. Post-procedure, patients were asked to complete a questionnaire to assess pain, discomfort and acceptability of the procedure, and to compare the current procedure with their previous unsedated TOE. Endoscope insertion rate, procedure duration, and side-effects were recorded.Results: Each group included 50 patients. With the exception of nasal pain, the tolerability and acceptance were significantly greater in the unsedated TNE group. Significantly more TNE patients (82%) found the current endoscopic procedure to be better than their previous TOE when compared with patients who had received a second TOE (12%). A repeat procedure was significantly more acceptable for TNE patients when compared to the TOE group (68% vs.16%). The duration of endoscopy was significantly shorter in TOE than in TNE (p

PubMed ID: 31155107, 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. © 2017, Fundacion Clinica Medica Sur. All rights reserved.

The hepatitis G virus (HGV) and transfusion-transmitted virus (TTV) are recently defined hepatitis viruses that the pathogenic roles in liver diseases are still not clear. It has been well known that some hepatitis virus, such as hepatitis C, might have an affinity to pancreatic islet cells. To investigate the relationship between the newly defined hepatitis viruses and diabetes mellitus (DM), we studied the prevalence of TTV and HGV in a type 2 diabetic patient population. Serum samples of 60 patients with DM and 45 healthy volunteers as control were taken. HGV RNA and TTV DNA was investigated by polymerase chain reaction. HGV was detected in none of diabetic patients (0%) and only one in control group (2.2%). However, TTV DNA was detected in 16 patients with DM (26%) and in five controls (11%). TTV was more prevalent in diabetic patients, but the difference between groups was not statistically significant (p > 0.05). These results revealed that TTV is more common in diabetic patients than in controls. At present, we don't know if this result is only a coincidence or a sign of potential association between TTV and DM. Further studies are certainly needed to elucidate a potential relationship.

Invasive bacterial infections have become the leading cause of morbidity and mortality among solid organ transplant recipients (SOTRs). Acinetobacter baumannii can cause a serious infection in SOTRs. Multidrug-resistant A. baumannii (MDR-Ab) represents a major problem in liver transplant recipients. Here, we presented a respiratory infection related to MDR-Ab pathogenesis in a patient who underwent liver transplantation due to acute hepatic failure. Accordingly, it has been emphasized that infections after the liver transplantation should be accomplished after due consideration of all relevant facts with a multidisciplinary approach. How to cite this article Balkan A, Balkan Y, Mete AÖ. A Case of Early detected Multidrug-resistant Acinetobacter baumannii Infection after Liver Transplantation. Euroasian J Hepato-Gastroenterol 2016;6(2):170-172.

We describe the diagnosis of a 77-year-old woman admitted to our outpatient department with a 3-month history of abdominal bloating and distension. Abdominal computed tomography revealed a large cystic lesion in the posterior segment of the right hepatic lobe, with a separated germinal layer and widespread ascites with dense internal echoes and septal appearance. The result of a serum Echinococcus indirect haemagglutination test was positive and findings were indicative of the spontaneous rupture of a hydatid cyst into the peritoneal cavity without trauma. Ascites is rarely seen in the course of hydatid disease, but can result from cyst rupture into the peritoneal cavity. This should be considered in the differential diagnosis of ascites, especially in areas such as Turkey, where hydatid disease in endemic.

Giris ve Amac:Ust gastrointestinal sistem kanamalari Gastroenterolojinin onemli ugras alanlarindan birini olusturmaktadir. Bu hastalarda on klinik degerlendirme en onemli basamaklardan birini olusturmaktadir. Bazi hastalar gastrointestinal sistem kanama on tanisi ile gonderilmelerine ragmen aktif kanama izlenmemektedir. Bu calismada, ust gastrointestinal sistem kanamasi tanisi ile merkezimize refere edilen hastalardan aktif kanamali hastalar ve bunlarin endoskopi bulgulari degerlendirildi. Gerec ve Yontem:Toplam 20 aylik bir surede klinigimiz Endoskopi Unitesi'ne ust gastrointestinal sistem kanama on tanisi ile refere edilen hastalar calismaya dahil edildi. Bu hastalarin endoskopi bulgulari ve aktif kanama oranlari kaydedildi. Veriler retrospektif olarak degerlendirildi. Bulgular: Bu sure icerisinde toplam 13661 ust gastrointestinal sistem endoskopisi yapilmistir. Bunlarin 951 tanesine (%7) ust gastrointestinal sistem kanama on tanisi ile erken endoskopik islem yapilmistir. 232 hastada (%24,4) aktif kanamali lezyon tespit edilmistir. Bu hastalarin 120 tanesinde (%52) duodenal ulser, 67 hastada (%29) gastrik ulser, 29 hastada (%12) ozofagus varisi, 16 hastada (%7) eroziv gastropati-bulbopati saptanmistir. Hastalarin 719'unda (%75,6) ise endoskopide tespit edilen aktif kanama yoktu. Sonuc:Erken donemde yapilan endoskopilerin cogunda aktif kanama olmamasi, klinik olarak hastalarin daha dikkatli de-gerlendirilmesi ve acil endoskopi gereken hastalarin iyi belirlenmesi gerekliligini gostermektedir. Bu ise hem isgucunun aktif ve verimli kullanilmasi hem de hastalarin tedavi yonlendirilmesinde onem teskil etmektedir.

Objective: To determine the prevalence and clinical impact of transfusion-transmitted virus (TTV) DNA in patients with chronic liver diseases in the Southeast Anatolia region of Turkey where hepatitis B and C viral infections are endemic. Subjects and Methods: Patients diagnosed with chronic liver disease by clinical, biochemical and histologic means were enrolled in the study. Serum samples of 60 patients (19 males, 41 females) with chronic liver diseases, and of 45 healthy volunteer blood donors as a control group were collected. The chronic liver disease group consisted of 11 patients with hepatitis B, 44 with hepatitis C and 5 with chronic liver disease of unknown etiology. Presence of TTV DNA was investigated by the polymerase chain reaction. Using a scoring system histological grading of inflammation and staging of fibrosis were performed only in the chronic hepatitis C group. Results: TTV DNA was detected in 47 (78%) patients with chronic liver disease and 5 (11%) volunteers in the control group. The difference was statistically significant (p < 0.001). Ten of the 11 (91%) patients with hepatitis B, 32 of 44 (73%) of those with hepatitis C-related chronic liver disease, and 5 of 5 (100%) of the patients with cryptogenic liver disease were positive for TTV DNA. Conclusion: TTV is highly prevalent in patients with chronic liver diseases in Southeast Anatolia, Turkey but no pathogenic effect attributable to TTV infection was detected.