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Papulosquamous drug eruptions are a group of skin lesions triggered by various drugs. Hepatitis B is an important health problem all over the world as well as in our country. Entekavir is a nucleoside analogue used in the treatment of chronic hepatitis B. A 56-year-old female patient using Entekavir for chronic hepatitis B for four years was admitted to our outpatient clinics with the complaints of dystrophic changes of the fingernails and toenails, and erythematous scaling lesions of the fingers and toes for one year. She had no history of drug use other than Entekavir. Laboratory examination revealed: HbsAg: positive, HBeAg: negative, anti-HBe: positive, HBV DNA: negative, total anti-HDV: negative, and alanine aminotransferase: 32 U/L. Biopsies were taken from the patient's finger and toe nails after three negative fungal examination of native smears. Biopsy results were consistent with drug eruptions and according to these results, the lesions were thought to be a side effect of Entekavir. Entekavir treatment was terminated and transaminase levels were followed at regular intervals. Mometasone furoate ointment and urea-containing moisturizers (2 times a day/seven days) were started for the treatment of skin lesions. Two weeks later, the lesions improved and the patient was called for follow-up at regular intervals. To the best of our knowledge, at present, there is only one case report in the literature about drug eruptions caused by Entekavir. Here, we describe the first patient who developed papulosquamous skin eruptions and nail disorders caused by Entekavir. [ABSTRACT FROM AUTHOR]

Endoscopic esophageal melanocytosis is a benign, uncommon pathologic condition characterized by melanocytic proliferation in the basal layer of squamous esophageal epithelium and increased melanin in the mucosa. Esophageal melanocytosis, also called melanosis, is a rare condition of benign melanocytic proliferation, found in 0.07% to 2.1% of consecutive gastrointestinal endoscopies. Because esophageal melanocytosis is uncommon, no specific symptoms or unique treatments have been reported. Little is known about the etiology and natural course of this condition, although it has been suggested to be a precursor of primary esophageal melanoma by some authors. Malignant melanoma of the esophagus is an aggressive metastatic malignancy. Melanocytic nevi and malignant melanoma should be considered in the differential diagnosis of esophageal melanocytosis. A sixty-four-year-old female patient was admitted to our outpatient clinic because of long-standing dyspeptic symptoms. Upper gastrointestinal endoscopy of the esophagus revealed linear, dark-brown pigmented areas extending from the proximal to distal esophagus which were resembling vascular structures and biopsy specimens were obtained. Esophageal biopsy material was consistent with esophageal melanocytosis. In this article, we report an elderly case of esophageal melanocytosis with a review of the diagnosis and differential diagnosis based on the literature. [ABSTRACT FROM AUTHOR]

Cyclosporine A (CsA) is a potent immunosuppressive agent used for organ transplantations and various autoimmune disorders. However, hepatotoxicity due to CsA remains one of the major side effects. The use of antioxidants reduces the adverse effects of CsA. The aim of this study was to determine the protective effects of erdosteine on CsA-induced liver injury through tissue oxidant/antioxidant parameters and to evaluate light microscopic alterations in rat-liver tissues. Rats were randomly divided into four experimental groups: The control group received sunflower oil (2 mL/kg/day, per orally; p.o.), while the other groups were treated with CsA (25 mg/kg/day, p.o.) or erdosteine (10 mg/kg/day, p.o.) or CsA+erdosteine, respectively. Serum aspartate aminotransferase and alanine aminotransferase levels, tissue malondialdehyde and nitric oxide levels, and superoxide dismutase, glutathione peroxidase and catalase enzyme activities were measured. Histological examination was performed. CsA caused a significant deterioration in the hepatic function tests, morphology, and gave rise to severe oxidative stress in the liver. Erdostein significantly improved the functional and histological parameters and attenuated the oxidative stresss induced by CsA. Erdostein protects liver tissue against oxygen free radicals and prevents hepatic dysfunction and morphological abnormalities associated with chronic CsA administration. [ABSTRACT FROM AUTHOR]

Gastric cancer is the fourth most frequent cancer and the second cause of cancer-related deaths worldwide. The early diagnosis of gastric cancer is fundamental in decreasing the mortality rates. It has been shown that MPV level is a sign of inflammation in hepatocellular carcinoma and pancreatic adenocarcinoma. The aim of this study is to examine whether MPV would be a useful inflammatory marker for differentiating gastric cancer patients from healthy controls. Thirty-one gastric cancer patients and 31 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. MPV level was significantly higher in pre-operative gastric cancer patients compared to healthy subjects (8.31 fL vs. 7.85; p: 0.007). ROC analysis suggested 8.25 fL as the cut-off value for MPV (AUC: 0.717, sensitivity: 61%, specificity: 81%). Surgical tumor resection resulted in a significant decrease in MPV level (8.31 fL vs. 7.55 fL; p: 0.001). No significant difference was found in MPV level between the post-operative group and control subjects. We did not find statistically significant difference between MPV and TNM stages. In conclusion, changes in MPV values may be used as an easily available biomarker for monitoring the healthy patients for GC risk and may prompt physicians to make an early diagnosis of GC. [ABSTRACT FROM AUTHOR]

Background/aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population., Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)±ribavirin (RBV) orombitasvir/paritaprevir/ritonavir±dasabuvir (PrOD)±RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed., Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90±54.60 U/L to 17.00±14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51±4.54 to 7.32±3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0±16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%)., Conclusion: LDV/SOF or PrOD±RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.

Many noninvasive serum markers have been studied to determine the liver fibrosis score (LFS). In this study, we aimed to investigate the association between thrombopoietin (TPO) levels and the stage of liver fibrosis in patients with chronic hepatitis B (CHB). Seventy-seven patients (64 active and 13 inactive) with CHB were included in this cross-sectional study. Patients were divided into three groups: In group 1, patients with mild or no fibrosis (F0, F1); in group 2, patients with significant fibrosis (F2-F4); and in group 3, inactive CHB carriers. Digital patient records were used to access pre-treatment laboratory findings including HBV DNA, HBeAg, ALT, AST, total bilirubin, PLT, albumin, INR. Liver biopsies were examined by experienced pathologists in our hospital who were blinded to the data of the patients. Serum TPO levels were measured using commercial ELISA kit. Serum TPO levels were significantly lower in patients with active CHB compared with the inactive carriers (528 vs 687.1 p=0.003). There was no statistically significant difference in TPO levels between the patients with and patients without significant fibrosis (568.9 vs 459.8 p=0.367). Correlation analysis with respect to ALT, AST, TPO, HBV-DNA level, platelet count, histological activity index (HAI) and liver fibrosis score was performed. TPO was only weakly positively correlated with AST, ALT and HBV-DNA levels (r=0.269 p=0.018; r=0.341 p=0.002; r=0.308 p=0.006; respectively) and no correlation in TPO with LFS and HAI was found (r=0.140 p=0.270, r=0.162 p=0.201; respectively). TPO was not associated with significant fibrosis (p=0.270). In conclusion, TPO levels were decreased in active CHB patients compared with inactive carriers but there was no correlation between TPO levels and the stage of fibrosis in active CHB.

Objective: The aim of this study is to determine the etiologies of serum gamma glutamyltransferase (GGT) elevation and relations between multiple etiologies prevalent in the Pursaklar region of Ankara in Turkey., Patients and Methods: The patients referred to the Family Medicine and Internal Medicine departments with various complaints from the Pursaklar region of Ankara between July 2000 and July 2002 were evaluated, and values for GGT, alkaline phosphatase (ALP), and alanine aminotransferase (ALT) levels were determined. GGT elevation was classified as being associated with hepatic, biliary, and other origins., Results: For GGT elevation, hepatobiliary etiologies were more prevalent. The most prevalent hepatic etiology was nonalcoholic steatohepatitis, followed by biliary etiologies. The most prevalent etiology of biliary origin was cholelithiasis. Other etiologies, in order of prevalence, were drug exposure and urinary infection. There were no gender-related differences for distribution of GGT elevation; however, the GGT values for women were higher than those for men.