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ÖZET Hepatit C, kronik karaciğer hastalığının yanı sıra hematolojik, dermatolojik, renal, otoimmün ve nörolojik bozukluklar gibi karaciğer dışı birçok semptom ve bulguya neden olabilir. Hepatit C enfeksiyonuna sekonder bağışıklık kompleksi ve komplemanların birikmesi nedeniyle küçük damarlarda vaskülit meydana gelir. Membranoproliferatif glomerülonefrit, hepatit C vakalarının dörtte birinden fazlasında görülebilir. Yirmi bir yıldır takip edilen hastalardan elde edilen sonuçlar böbrek tutulumunun malign prognoz belirtisi olduğuna işaret etmektedir. Ancak bu hastalarda son dönem böbrek yetmezliği sık görülmemektedir. Dolaşımdaki krioglübülinlerin laboratuvarda saptanması, hipokomplementemi ve romatoid faktör pozitifliği hepatit C serolojisinin teşhisine yardımcı olur. Bu hastalar tipik olarak düşük C4 değerleri gösterirken, normal veya normale yakın C3 değerleri gösterirler. Olgumuzda aktif kronik hepatit C pozitifliği nefroloji servisine nefrotik düzeyde proteinüri, hematüri, böbrek yetmezliği ve jeneralize ekzantem nedeniyle konsülte edilen hasta üzerinden tartışılmıştır. Anahtar kelimeler: Fokal nekrotizan glomerülonefrit, HCV, mikst kriyoglobulinemi, rituksimab

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 virus was found to have effects not only in the lungs but also in many different organs. We aimed to evaluate the management of our patients with inflammatory bowel disease in this pandemic, the incidence of coronavirus disease 2019 in terms of clinical, medical treatment, and features of inflammatory bowel disease, and to investigate the effects of the severe acute respiratory syndrome coronavirus 2 on this particular group of patients. METHODS: During the coronavirus disease 2019 pandemic, 207 patients who had inflammatory bowel disease for at least 6 months were questioned for coronavirus disease 2019 at their outpatient clinic admissions, and their medical records were evaluated prospectively. RESULTS: Of the 207 patients, 146 had Crohn’s disease. The mean disease duration was determined as 118.15 ± 72.85 months. Of the patients, 127 (61.4%) were using mesalazine, 110 (53.1%) azathioprine, and 148 (71.5%) biological agents. It was found that 66 (31.9%) patients changed their medications during the coronavirus disease 2019 pandemic. As a medication change, anti-Tumor Necrosis Factor (TNF) dose was observed to be omitted most frequently at a rate of 80%. Diarrhea was present in 20.8%, abdominal pain in 20.3%, nausea in 10.6%, anorexia in 13.5%, and weight loss in 15.9% of the patients. Twelve (5.79%) patients were diagnosed with coronavirus disease 2019. Lung involvement was present in 11 (91.7%) of the patients diagnosed with coronavirus disease 2019. Of the patients diagnosed and not diagnosed with coronavirus disease 2019, 75% vs. 71.6% were using biological agents (P = .80), respectively. Half of the patients diagnosed with coronavirus disease 2019 were active in terms of inflammatory bowel disease at the time of diagnosis, and 2 of these patients were severely active. CONCLUSION: The incidence of coronavirus disease 2019 infection in patients with inflammatory bowel disease was not different from the general population during the severe acute respiratory syndrome coronavirus 2 pandemic. Coronavirus disease 2019 infection does not progress with poor prognosis in patients with inflammatory bowel disease who receive immunosuppressive therapy including biological agents.

Chronic hepatitis B virus (HBV) infection is a major cause of hepatocellular carcinoma (HCC). Circulating cell-free DNA (cfDNA) methylation of tumor suppressor genes are emerging potential biomarkers in HCC. We aimed to evaluate the cfDNA methylation status of RASSF1 and CDKN2AIP genes in patients with liver cirrhosis (LC) with or without HCC caused by HBV.A total of 47 patients with HBV cirrhosis were included in the study. Patients were divided into two groups: HCC and LC (HCC+LC, n=22) and HBV cirrhosis only (LC, n=25). cfDNA was isolated from the plasma samples of the patients. Methylation analysis was performed for RASSF1 and CDKN2AIP genes.Mean methylation percentage of CDKN2AIP gene was 0.001±0.004% in the HCC+LC group and 0.008±0.004 % in the LC only group. The mean methylation percentage of RASSF1 gene was 5.1±16.1% in the HCC+LC group and 9.7±25.9% in the LC only group. The methylation rate of CDKN2AIP was significantly lower in the HCC+LC group (p=0.027). A positive correlation was found with the absence of cfDNA methylation of CDKN2AIP gene in the presence of HCC (R=0.667, p=0.018).cfDNA methylation of CDKN2AIP and RASSF1 genes may provide important diagnostic information regarding the development of HCC in the setting of HBV cirrhosis.

Intestinal malrotation is a developmental anomaly characterized by a midgut fixation disorder and failure to complete its normal fetal rotation around the superior mesenteric artery inside the peritoneal cavity. Malrotation is a rare cause of mechanical intestinal obstruction in adults. It may manifest as an emergency condition or with chronic abdominal symptoms. Although its diagnosis remains difficult, early diagnosis and treatment usually yield favorable outcomes. Intestinal malrotation rarely has an asymptomatic course, in which the diagnosis is usually made incidentally. Multislice computed tomography is quite helpful for making a correct diagnosis. In this study, we reported a 56-year-old patient incidentally who was detected to have intestinal malrotation and was managed symptomatically after presenting at our clinic with signs and symptoms of intestinal obstruction; we also provided a discussion of the relevant literature.

WOS: 000341256700017, PubMed ID: 25126174, Objective: Fourteen brain death cases diagnosed in Mart 2012-May 2013 period in Tokat State Hospital were studied retrospectively. CT angiography experience about those cases was shared, and use of CT angiography in confirmation of brain death was discussed. Material and Methods: All 14 cases were patients on mechanical ventilator, who did not respond to medical and surgical treatments at intensive care unit and were diagnosed clinically with brain death. All of these patients had CT angiography as a confirmatory test using a 4-slice CT scanner in Radiology department in Tokat State Hospital. Findings: Six of the patients were female and eight were male. All of them were referred from intensive care unit and had clinical brain death diagnosis before CT angiography. In the evaluation of CTA, four-point scoring involving opacification loss in both ICVs and cortical segments of MCA was used. CTA examinations confirmed brain death diagnoses in all patients who had clinical brain death diagnoses, and no confliction between CTA findings and clinical diagnoses was observed. Conclusion: Demonstrating the lack of cerebral circulation is a necessity for confirmation of brain death diagnosis. While conventional angiography remains the standard method, CTA emerged as an alternative method. In parallel to increase in prevalence of organ implants, CTA, a fast and efficient method, has been increasingly used in confirmation of brain death diagnoses.

Alkaptonuria (AKU; McKusick No. 203500), a rare hereditary disorder of the phenylalanine catabolism, was the first disease to be interpreted as an inborn error of metabolism (A. E. Garrod, 1902, Lancet 2: 1616-1620). AKU patients are deficient for homogentisate 1,2-dioxygenase (HGO; EC 1.13.11.5). This enzymatic deficiency causes homogentisic aciduria, ochronosis, and arthritis. Recently we cloned the human HGO gene and showed that AKU patients carry two copies of a loss-of-function HGO allele. Here we describe the complete nucleotide sequence of the human HGO gene and the identification of its promoter region. The human HGO gene spans 54,363 bp and codes for a 1715-nt-long transcript that is split into 14 exons ranging from 35 to 360 bp. The HGO introns, 605 to 17,687 bp in length, contain representatives of the major classes of repetitive elements, including several simple sequence repeats (SSR). Two of these SSRs, a (CT)n repeat in intron 4 and a (CA)n repeat in intron 13, were found to be polymorphic in a Spanish population sample. The HGO transcription start site was determined by primer extension. We report that sequences from -1074 to +89 bp (relative to the HGO transcription start site) are sufficient to promote transcription of a CAT reporter gene in human liver cells and that this fragment contains putative binding sites for liver-enriched transcription factors that might be involved in the regulation of HGO expression in liver.

The aim of this CT-based study was to investigate the frequency of splenic infarction (SI) following conventional open gastrectomy performed for gastric malignant neoplasms. 20 patients who underwent subtotal or total gastrectomy, omentectomy, and D2 lymph node dissections preserving the spleen for gastric malignant neoplasms were retrospectively reviewed. Patients with postoperative CT scans within 3 months were enrolled in this study. CT imaging was performed with a 64-row multidetector CT scanner. Abdominal CT scan with precontrast and postcontrast portal phase images was performed on 19 of the patients, while pulmonary CT angiography was performed on 1 patient for chest pain. Second postoperative control abdominal CT images were also present for 3 of the 5 patients with SI. These examinations were also reviewed for the evolution of the SI’s. SI was detected in 5 of the patients (25%) at a postoperative early stage. A single infarct area was detected in 4 of the 5 patients while two distinct infarct areas were present in one patient. The infarct areas in two patients disappeared on the second postoperative control CT. A decrease in the size of the SI area in 1 patient was also detected on the second postoperative control CT scan. The frequency of SI as a complication of abdominal surgeries tends to increase in CT-based studies. We have detected the highest frequency in the literature and suggest that SI, especially when accompanying D2 lymphadenectomy, should be included in the list of early stage gastrectomy complications.