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Background and Aims: About 400 000 patients with hepatitis C virus die from cirrhosis-related complications and hepatocellular carcinoma every year. Direct-acting antivirals provide a sustained virologic response in more than 90% of patients with hepatitis C virus infection. We aimed to evaluate the alteration of the non-invasive fibrosis index in patients with hepatitis C virus who were treated with direct-acting antivirals. Materials and Method: Patients with hepatitis C virus who received a complete course of direct-acting antivirals were analyzed. FIB-4 and APRI were calculated for each patient. Results: Of the 88 patients, 46 (52%) were males, and 21 (23.8%) were cirrhotics. The mean age was 58 years. The significant decrease was showed in the non-invasive scores compared from the baseline to the end of treatment. There was a statistically significant drop in mean FIB-4 and APRI scores from baseline to post sustained virologic response (p < 0.001). In the long-term follow-up, it was observed to continue low FIB-4 and APRI at 15 months post sustained virologic response. Mean follow up-time was 27.8 ± 24.3 months in our study, and just one patient was diagnosed with hepatocellular cancer after direct-acting antivirals treatment during follow-up. Conclusion: An early decline in FIB-4 and APRI scores can be related to a decrease in liver enzymes. Nonetheless, maintaining a low level of non-invasive markers has been linked to a reduction in necroinflammation., Giriş ve Amaç: Her yıl yaklaşık 400 000 hepatit C virüs hastası siroza bağlı komplikasyonlardan ve hepatosellüler karsinomadan ölmektedir. Doğrudan etkili antiviraller, hepatit C virüs enfeksiyonu olan hastaların %90’ından fazlasında sürekli bir virolojik yanıt sağlar. Bu çalışmada doğrudan etkili antivirallerle tedavi edilen hepatit C virüslü hastalarda non-invaziv fibrozis indeksindeki değişikliği değerlendirmeyi amaçladık. Gereç ve Yöntem: Doğrudan etkili antiviral teadavisi alan hepatit C virüslü hastalar analiz edildi. Her hasta için FIB-4 ve APRI hesaplandı. Bulgular: Toplam 88 hastanın 46'sı (%52) erkek, 21'i (%23.8) sirotikti. Ortalama yaş 58 yıl idi. Başlangıçtan tedavi bitimine kadar non-invaziv skorlarda anlamlı düşüş gösterildi (p < 0.001). Başlangıçtan sürekli bir virolojik yanıt sonrasına kadar ortalama FIB-4 ve APRI skorlarında istatistiksel olarak anlamlı bir düşüş vardı (p < 0.001). Uzun süreli takipte, sürekli bir virolojik yanıt sonrası 15 ayda düşük FIB-4 ve APRI'nin devam ettiği gözlendi. Çalışmamızda ortalama takip süresi 27.8 ± 24.3 ay olup, takipte doğrudan etkili antiviral tedavisi sonrası sadece bir hastaya hepatosellüler kanser tanısı konuldu. Sonuç: FIB-4 ve APRI skorlarındaki erken düşüş, karaciğer enzimlerindeki azalma ile ilişkili olabilir. Bununla birlikte, takiplerde düşük düzeyde invaziv olmayan skorların devam etmesi, nekroinflamasyonda bir azalma ile ilişkilendirilmiştir.

The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t)ide analogs after liver transplantation.

INTRODUCTION: Sarcopenia is a geriatric syndrome which is defined as the decrease in muscle mass, muscle strength and muscle function. Low skeletal muscle mass and quality before transplantation are independent risk factors for mortality after liver transplantation. In this study, muscle mass and muscle quality were evaluated before transplantation and the effects of these measurements on the mortality rate after liver transplantation were investigated. METHODS: We retrospectively analyzed 54 adult patients who underwent liver transplantationat our center between January 2015 and October 2018. Demographic characteristics, computed tomography (CT) and laboratory findings of these patients were reviewed. SMI (skeletal muscle mass index), VSR (visceral-to-subcutaneous adipose tissue area ratio) and IMAC (intramuscular adipose tissue content) were measured from axial CT sections. The normal cut-off values of SMI, VSR and IMAC were calculated from CT images of 54 healthy donors between 2013 and 2018. The cutoff values were determined for men and women separately using the median data. RESULTS: The median age of 54 patients was 48.9 years (22–67 years). Fourty of 44 patients were male (74%). Thirty-six patients (66,6 %) had living donor transplantation, while 18 had (33.3%) had cadaveric. The indications of transplantation were hepatocellular carcinoma (HCC) in 20 patients (37%), viral hepatitis in 13 (24%), cryptogenic in liver cirrhosis in 5 (9,2%), cholestatic diseases in 4 (7,4%), toxic in 3 (5,5%), metabolic in 3 (5,5%), vascular liver diseases in 2 (3,7%), alcoholic liver disease in 1 (1,8%) and other causes in 2 (3,7%). A total of 6 (11.1%) patients died in this follow-up period. Forty-four patients (81.4%) had CT scan before the operation. There were 33 patients (75%) with preoperative low SMI (low muscle mass), 35 patients (79.5%) with high IMAC (low muscle quality), and 29 patients (65.9%) with high VSR (visceral adiposity). No significant correlations were found between pretransplant VSR, SMI and IMAC and other parameters (donor age, MELD-Na score, operative time, operative blood loss, BMI and length of ICU stay (p >0.05). There were significant relationships between SMI and patient hemoglobin level (12.6 versus 11.1 p=0.023) and IMAC and age (57 versus 51 p=0.05). The 1- and 3-year survival probabilities in patients with low SMI and normal SMI were 90.9% and 90.9% versus 86.1% and 90.9%, respectively. The 1- and 3-year survival probabilities in patients with high VSR and normal VSR were 86.2% and 100% versus 86.2 %and 87.5%, respectively. The 1- and 3-year survival probabilities with high IMAC were 88.6 % and 84.1%. No patients with normal IMAC were lost in follow up period; so the 1 and 3 year survivals were 100%. CONCLUSION: Sarcopenia is seen in a significant number of patients with cirrhosis awaiting liver transplantation. Preoperative SMI, VSR and IMAC can predict post-transplant mortality.

INTRODUCTION: Toxic hepatitis is a common cause of elevated liver enzymes. In the literature, there are case reports about the development of hypercholesterolaemia and related pseudohyponatremia as a result of the deterioration of lipoprotein excretion in the course of toxic hepatitis. In this article, we present a case of hyponatremia due to toxic hepatitis induced hypercholesterolaemia. CASE: The 58-year-old male patient was hospitalized 5 weeks ago at a different hospital because of hyperglycemia. After blood glucose regulation, atorvastatin, terbinafine, pancreatin, vildagliptin, desloratadine, domperidone were prescribed and discharged. Liver enzymes were found to be high in their follow-up and no specific factor was found in the etiology. T. bilirubin and d. bilirubin were found high and Na was found low in the patient who started jaundice 3–4 days ago. The patient was admitted to the clinic with the diagnosis of acute hepatitis. His medical history included toxic hepatitis due to terbinafine use (6 years ago), diabetes mellitus, hyperlipidemia, and onychomycosis. The patient was considered as toxic hepatitis due to terbinafine use because of its history of toxic hepatitis due to terbinafine use. Liver enzymes regressed in follow-up. In the patient with euvolemic hyponatremia, in the laboratory tests performed for etiology, aldosterone, plasma renin activity, sodium (24 hours in urine), cortisol (fasting), TSH were normal and measured serum osmolarity 275 mOsm/kg, calculated serum osmolarity 257 mOsm/kg, osmotic gap 18, urine osmolarity 618 mOsm/kg were found. Isoosmotic hyponatremia was considered. Total protein, albumin/globulin ratio, and lipid profile were re-studied despite normal results and T. cholesterol:1274 mg/dl, triglycerides:208 mg/dl, LDL:1160 mg/dl, total protein 5.53 g/dl, albumin 3.30 g/dl were found. The patient was considered to have pseudohyponatremia due to hypercholesterolemia. The measured serum viscosity was 2.55 cP. Because of he had abdominal pain, he was started lipid apheresis and had 3 sessions. Sodium and lipid profile of the patient improved, abdominal pain regressed. Hyponatremia and hypercholesterolemia were not observed during the follow-up period. DISCUSSION: Toxic hepatitis is a common cause of elevated liver enzymes. There are reports in the cases of cholestatic acute hepatitis that the lipoproteins are not discharged into bile and that hypercholesterolemia may develop in these patients. In the literature, there are case reports of hypercholesterolemia and associated pseudohyponatremia in cholestatic liver diseases. Our case also had cholestatic liver damage. The patient who had normal lipid profile and sodium level before liver injury was diagnosed pseudohyponatremia due to cholestatic liver injury related hypercholesterolemia. CONCLUSION: When hyponatremia is detected in patients presenting with cholestatic liver injury, pseudohyponatremia due to hypercholesterolemia should be kept in mind in addition to common etiologic factors.

INTRODUCTION: Viral hepatitis is a public health problem and causes significant mortality and morbidity. HCV is the second most common chronic viral infection in the world. According to 2015 data, 71 million people are living with chronic HCV. It is revealed that there were 1.75 million of new HCV infection cases across the world in 2015 (Global incidence rate: 23.7/100.000). In our country, the prevalence of anti-HCV positivity is estimated around 0.5 to 1%. Accordingly, it is thought that 350.000 to 750.000 people are infected with HCV and that the majority of those HCV infected patients are not aware of the situation. In this study, we aimed to determine how many of the patients with anti-HCV positivity who had anti-HCV positivity at the screening before the interventional procedures were aware their situation. METHODS: Patients who had anti-HCV positivity during screening tests in the last 5 years were reviewed retrospectively. The demographic data of these patients were recorded and the patients undergoing further investigation and treatment were identified. RESULTS: Anti-HCV was positive in 1549 patients between 2013–2018. The mean age of the patients was 61.36 (range 9–95). 727 (46.9%) of the patients were not referred for further investigation. Of the 822 patients (53.1%) who were further examined, 420 (27.1%) were HCV RNA negative and 402 (26%) were HCV RNA positive. The genotype was determined in 333 of HCV RNA positive patients. Of these patients, 317 were genotype 1, 4 were genotype 2, 10 were genotype 3 and 2 were genotype 4. Hepatic examination revealed Child A cirrhosis in 54 patients, Child B in 10 patients and Child C cirrhosis in 10 patients. 17 patients developed HCC and 3 of these patients were also positive for Hbs Ag. Fourteen patients required liver transplantation due to hepatic failure secondary to HCV or hepatocellular cancer (HCC). CONCLUSION: There is not enough awareness for hepatitis C infection which is one of the most important causes of acute and chronic liver disease and has serious morbidity and mortality. Even in a tertiary health facility, one of the two patients with anti-HCV positivity is not guided for further examination.

We designed this study to determine diagnostic value of computerized tomography (CT) that was proven nodules in explant liver. We compared between CT images of liver nodules before liver transplantation(LT) and histological findings nodules of explant liver. 75 (%73.5) patients were male and 27 ( %26.5) patients were female. Average age was 47.3±11,8. LT was performed to cause 33 (%32.3) patients viral hepatitis, 7(%6.8) patients fulminant hepatitis, 27(%26.5) patients hepatocellular carcinoma (HCC) and 35 (%34.4) patients other etiologies. Serum alpha-fetoprotein median level was 4,3 ng/ml (0,5–608).63 of 102 (%61.8) patients were not determined nodules in explant liver. Histological findings in 19 (%18.7) patients HCC, 11(%10,7) displastic nodules and HCC, 7 (%6.9) patients displastic nodules, 2(%1.9) patients regenerative nodules in explant liver. We have reached CT images 33 of 102 patients. It was compared between nodules that similar locations explant liver and total 55 nodules that determine by CT. 17(%31) are regenerative nodules, 30 (%54.5) nodules HCC and 8(%14.5) nodules displastic in CT. 6 ( %10.9) nodules regenerative nodules, 37 (%67.3) nodules HCC, 8(%14.5) nodules displastic, 3(%5) nodules displastic nodules and HCC, 1(%1.8) nodule was regenerative nodule and HCC focus in explant liver. Histological findings of explant liver are gold standart to diagnostic value of HCC diagnosis. The diagnostic value of CT to determine HCC sensitivity %70.7 (29/41) and specifity %92.9 (13/14) (p

INTRODUCTION: Giant cell hepatitis is a disease usually described in the newborn and rarely seen in adults. Various viruses, drugs and autoimmune diseases are responsible for etiology. In some case series, autoimmune liver disease is involved in the etiology of approximately 40% of cases. Clinical spectrum; changing from acute hepatitis to chronic liver disease, can lead to fatal liver failure. CASE: A 19-year-old man visited our hospital due to generalized symptoms. In 2013, a diagnosis of autoimmune hepatitis was made in the outside center. Medical treatmant with methylprednisolone, azathioprine and ursodeoxycholic acid was started. Patient was admitted to intensive care unit due to systemic infections and septic status. Therefore treatment of azatiopurine was discontinued. The patient developed hyponatremia and encephalopathy, and referred to our institution for evaluation of liver transplantation. On physical examination; the patient was lethargic and icteric, had flapping tremor, rales in the middle and upper zones of the lungs and generalized acid. (MELD score: 35, Child-Pugh score: 14 (C)). Coombs positive hemolytic anemia was present in the patient. When the liver pathology specimens from 2013 were re-evaluated; chronic active hepatitis which including multinuclear giant hepatocytes were reported. The patient was diagnosed as giant cell hepatitis and autoimmune hemolytic anemia. Intravenous methylprednisolone (40 mg) treatment was started. We planned liver transplantation for the patient due to chronic liver disease-acute exacerbation. But liver transplantation could not be done due to infection status. The patient have developed cardiac arrest secondary to pneumonia/sepsis and died on the 9th day of hospitalization. DISCUSSION: Giant cell hepatitis is a progressive disease which has high mortality. If the liver transplantation is not performed, survival would be approximately 50%. Giant cell hepatitis is a histopathological diagnosis that can be caused by many etiological factors rather than a specific disease. In the correct diagnosis and treatment of this pathology, both clinical and pathological examinations require more than routine examinations. Since the disease is progressive and mortality is high, liver transplantation should be considered during the follow-up period.

Background and Aims: Mallory-Weiss syndrome is responsible for upper gastrointestinal bleeding with a 1%-4% frequency. Most patients with Mallory-Weiss syndrome have a clinically mild course and do not require specific endoscopic treatment. However, some patients with Mallory-Weiss syndrome have severe bleeding. Endoscopic treatment of Mallory-Weiss syndrome is not standardized when compared with that of bleeding ulcers. Here we aim to share our patients’ demographic properties, applied endoscopic treatments, and clinical courses of patients. Materials and Methods: We researched our patients with Mallory-Weiss syndrome in Türkiye Yüksek İhtisas Training and Research Hospital Endoscopic Unit between 2010 and 2017. Results: Overall, 37 patients (males/females: 29/8, mean age: 63.4±19.4 years) were included in the study. Mallory-Weiss syndrome occurred in 15 patients in whom routine endoscopic procedures were performed. Stigmata of active bleeding were observed in 27 patients. Primary hemostasis was achieved in 25 patients with 92.5% frequency. Endoscopic procedures including placement of hemoclips, injection of epinephrine, and thermocoagulation with a heater probe were performed in patients with stigmata of active bleeding. Patients were divided into two groups depending on whether the origin of Mallory-Weiss syndrome was iatrogenic. Hospital stays, erythrocyte transfusion rates, primary hemostasis, stigmata of active bleeding, and frequencies of hiatal hernia were compared between the two groups. There were no differences between the two groups. Placement of hemoclips was performed in 27 patients; 19 patients received hemoclips alone whereas 8 patients received hemoclips with epinephrine injections. Mortality was not observed in any of our patients. Conclusion: Although most patients with Mallory-Weiss syndrome have benign clinical courses, it is important to keep in mind that Mallory-Weiss syndrome can be associated with severe bleeding. Hemoclip placement is an effective endoscopic treatment method in Mallory-Weiss syndrome., Giriş ve Amaç: Mallory-Weiss sendromu üst gastrointestinal sistem kanamalarının %1-4 kadarından sorumludur. Çoğu Mallory-Weiss sendromu spesifik endoskopik tedavi gerektirmeyen bir şekilde hafif kanama ile seyreder; bununla beraber bazı olgularda kanama abondan olabilir. Ülser kanamalarından farklı olarak Mallory-Weiss sendromunda endoskopik tedavi çok iyi standartize edilmemiştir. Biz bu çalışmamızda kendi olgularımızın demografik özelliklerini, uygulanılan endoskopik tedavileri ve hastaların klinik seyirlerini karşılaştırmayı hedefledik. Gereç ve Yöntem: Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Endoskopi ünitesinde 2010-2017 tarihleri arasında Mallory-Weiss sendromu tanısı almış hastalar retrospektif olarak incelendi. Bulgular: Çalışmaya toplam 37 hasta (erkek/kadın: 29/8, yaş ortalaması: 63,4±19,4) dahil edildi. Bu hastaların Mallory-Weiss laserasyonu endoskopi esnasında oluşan hasta sayısı 15 olup hastaların 27 tanesinde aktif kanama belirtisi vardı. Primer hemostaz 25 hastada %92,5 sıklıkta izlendi. Aktif kanama belirtisi olan hastalara uygulanılan endoskopik tedaviler adrenalin enjeksiyonu, klips uygulaması, heater prob idi. Mallory-Weiss sendromu oluşumuna göre hastalar iatrojenik Mallory-Weiss sendromu olan ve olmayan hastalar olarak iki gruba ayrıldı. Hastanede yatış varlığı, eritrosit süspansiyonu verilme ihtiyacı, aktif kanama belirtisi varlığı, hiatal herni varlığı ve uygulanılan endoskopik tedaviler karşılaştırıldığında bu parametreler açısından gruplar arasında fark yoktu. Toplam 27 hastaya klips uygulaması yapılmıştı; bu hastaların 19 tanesine sadece klips uygulanırken 8 tanesine ise klips ile beraber adrenalin uygulaması yapıldı. Hastalarımızda mortalite izlenmedi. Sonuç: Mallory-Weiss sendromlu çoğu hasta klinik olarak benign seyir gösterse de bu hastaların şiddetli kanama ile beraber olacakları akılda tutulmalıdır. Hemoklipsler tedavide etkin ve güvenli bir endoskopik tedavi yöntemidir.

Aim:Primary biliary cholangitis is a chronic cholestatic liver disease mainly affects middle age women. Persistently elevated cholestatic liver enzymes, normal biliary imaging and the presence of antimitochondrial antibodies are key elements of the diagnosis. It was demonstrated that disease can progress under ursodeoxycholic acid (UDCA) treatment. Our aim is to demonstrate response to treatment of PBC patients. Also we aim to determine accuracy rate of Paris-I, Paris-II, Toronto and Barcelona criteria for predict UDCA treatment in PBC.Material and Method:82 PBC patients diagnosed between 2000-2010 were investigated retrospectively. Only patients who were treated UDCA with a daily 13-15 mg/kg dose at least two years were included into the study. The diagnosis of PBC was made by two of the following criteria: The presence of AMA, elevated cholestatic liver enzymes and biopsy.Results: Patients biochemical parameters at 3., 6., 12., 24., 36., 48. and 60. months were compared between Paris-I, Paris-II, Toronto and Barcelona criteria. Paris-I was found the best test to predict treatment response (%71,7). Other tests are less successful to predict treatment response (Toronto:%54,6, Barcelona: %50,6 and Paris-II:%47,4). Beyond the second year of the treatment, successful ratio of tests for predicting response to treatment were increased.29.09Conclusion: Although liver biochemical tests are getting better in the third month of UDCA treatment, accuracy rate of Paris-I, Paris-II, Toronto and Barcelona increases after the second year of the treatment. In our study we found low levels of the accuracy rate of these tests.&nbsp, Giriş ve Amaç: Primerbiliyer kolanjit çoğunlukla orta yaş kadınların etkilendiği, kronik kolestatikbir karaciğer hastalığıdır. Persistan kolestatik karaciğer enzim yüksekliği,normal biliyer görüntüleme ve antimitokondrial antikor varlığı primer biliyerkolanjit teşhisi için gereklidir. Ursodeoksikolik asit tedavisi altındaki bazı hastagruplarında hastalığın ilerlediği gösterilmiştir. Biz kliniğimizde primerbiliyer kolanjit tanısı ile izlenen hastaların tedavi sonuçlarını vermeyi veParis-I ve Paris-II, Toronto ve Barselona kriterlerine göre ursodeoksikolikasit yanıtını ön görmede testlerin doğruluk oranlarını göstermeyi amaçladıkGereç veYöntem: Yüksek İhtisas Hastanesi HepatolojiBölümü’nde 2000-2010 yılları arasında primer biliyer kolanjit tanısı alan 82 hasta retrospektifolarak incelendi. Primer biliyer kolanjit tanısı antimitokondrialantikorpozitifiliği, alkalen fosfataz enzim yüksekliği ve/veya biyopsi ile konuldu. Enaz 2 yıl boyunca ursodeoksikolik asit 13-15 mg/kg/g dozunda alanhastalar çalışmaya alındıSonuçlar: Hastalar 3. ay, 6 ay,1. yıl, 2. yıl, 3. yıl, 4. yıl ve 5. yıl biyokimyasal yanıt açısından Barselona,Paris I-II ve Toronto kriterleri açısından değerlendirildi. Tedaviye yanıtı öngörmede en başarılı test doğruluk oranına göre Paris I (%71.7) olarakhesaplandı. Hastalarımızda tedavi başarısını ön görmekte en başarılı diğertestler sırası ile Toronto (%54.6), Barselona (%50.6) ve Paris-II (%47.4) olaraksaptandı. Tedavi yanıtını ön görmedeki başarı tüm testlerde 2 yıldı vesonrasında başarı oranları artmakta idi.Sonuç: Ursodeoksikolikasit tedavisibaşlanan hastalarda 3. ayda karaciğer biyokimya testlerinde iyileşmegörülmesine rağmen, ursodeoksikolik asit tedavi yanıtını ön görmedekullanılan testlerin doğruluk oranları 2. yılda artmakta idi. Çalışmamızda tanıtestlerinin doğruluk oranı düşük idi. Bu nedenle daha geniş hasta grupluçalışmalar yapılıp sonuçlarımızın doğrulanması gerekmektedir.AbstractAim: Primary biliary cholangitis is achronic cholestatic liver disease mainly affects middle age women. Persistentlyelevated cholestatic liver enzymes, normal biliary imaging and the presence ofantimitochondrial antibodies are key elements of the diagnosis. It wasdemonstrated that disease can progress under ursodeoxycholic acid (UDCA)treatment. Our aim is to demonstrate response to treatment of PBC patients.Also we aim to determine accuracy rate of Paris-I, Paris-II, Toronto andBarcelona criteria for predict UDCA treatment in PBC. Material and Method: 82 PBC patientsdiagnosed between 2000-2010 were investigated retrospectively. Only patientswho were treated UDCA with a daily 13-15 mg/kg dose at least two years wereincluded into the study. The diagnosis of PBC was made by two of the followingcriteria: The presence of AMA, elevated cholestatic liver enzymes and biopsy. Results: Patients biochemicalparameters at 3., 6., 12., 24., 36., 48. and 60. months were compared betweenParis-I, Paris-II, Toronto and Barcelona criteria. Paris-I was found the besttest to predict treatment response (%71,7). Other tests are less successful topredict treatment response (Toronto:%54,6, Barcelona: %50,6 andParis-II:%47,4). Beyond the second year of the treatment, successful ratio of testsfor predicting response to treatment were increased. Conclusion: Although liverbiochemical tests are getting better in the third month of UDCA treatment,accuracy rate of Paris-I, Paris-II, Toronto and Barcelona increases after thesecond year of the treatment. In our study we found low levels of the accuracyrate of these tests.Giriş ve Amaç: Primerbiliyer kolanjit çoğunlukla orta yaş kadınların etkilendiği, kronik kolestatikbir karaciğer hastalığıdır. Persistan kolestatik karaciğer enzim yüksekliği,normal biliyer görüntüleme ve antimitokondrial antikor varlığı primer biliyerkolanjit teşhisi için gereklidir. Ursodeoksikolik asit tedavisi altındaki bazı hastagruplarında hastalığın ilerlediği gösterilmiştir. Biz kliniğimizde primerbiliyer kolanjit tanısı ile izlenen hastaların tedavi sonuçlarını vermeyi veParis-I ve Paris-II, Toronto ve Barselona kriterlerine göre ursodeoksikolikasit yanıtını ön görmede testlerin doğruluk oranlarını göstermeyi amaçladıkGereç veYöntem: Yüksek İhtisas Hastanesi HepatolojiBölümü’nde 2000-2010 yılları arasında primer biliyer kolanjit tanısı alan 82 hasta retrospektifolarak incelendi. Primer biliyer kolanjit tanısı antimitokondrialantikorpozitifiliği, alkalen fosfataz enzim yüksekliği ve/veya biyopsi ile konuldu. Enaz 2 yıl boyunca ursodeoksikolik asit 13-15 mg/kg/g dozunda alanhastalar çalışmaya alındıSonuçlar: Hastalar 3. ay, 6 ay,1. yıl, 2. yıl, 3. yıl, 4. yıl ve 5. yıl biyokimyasal yanıt açısından Barselona,Paris I-II ve Toronto kriterleri açısından değerlendirildi. Tedaviye yanıtı öngörmede en başarılı test doğruluk oranına göre Paris I (%71.7) olarakhesaplandı. Hastalarımızda tedavi başarısını ön görmekte en başarılı diğertestler sırası ile Toronto (%54.6), Barselona (%50.6) ve Paris-II (%47.4) olaraksaptandı. Tedavi yanıtını ön görmedeki başarı tüm testlerde 2 yıldı vesonrasında başarı oranları artmakta idi.Sonuç: Ursodeoksikolikasit tedavisibaşlanan hastalarda 3. ayda karaciğer biyokimya testlerinde iyileşmegörülmesine rağmen, ursodeoksikolik asit tedavi yanıtını ön görmedekullanılan testlerin doğruluk oranları 2. yılda artmakta idi. Çalışmamızda tanıtestlerinin doğruluk oranı düşük idi. Bu nedenle daha geniş hasta grupluçalışmalar yapılıp sonuçlarımızın doğrulanması gerekmektedir.

Aim: We investigated the role ofthe H63D mutation on the development of hepatic iron overload and hepatic injury in non-alcoholic Steatohepatitis patients and its association with insulin resistance and metabolic alterations. Material and Methods: Thirty-two patients with NASH, who were diagnosed at Hacettepe University Gastroenterology Outpatient Clinic depending on clinic and laboratory findings, were included into study. Metabolic syndrome was sought. Waist hip ratio and body mass index were calculated. H63D gene mutation, iron level at serum and liver biopsy specimens and histopathologic exam on liver biopsy specimens were studied in study group. Fasting and post-prandial blood sugar, lipid profile, 75-gr-glucose tolerance test and HOMA insulin resistance were measured to document the insulin resistance and metabolic syndrome. Results: Thirty-two patients with mean body mass index was 28.1 kg/m2i3,3 were included in study. Hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, insulin resistance were found at 25 %, 37 %, 56 %, 28 and 39 %, respectively. Serum ferritin and transferrin saturation values were within normal limits in all but except patients. Hepatic iron concentration was 1600ug in 12 (41%) of patients. H63D mutation was homozygote in (3%) and heterozygote 12 (40%) patients. Therefore the H63D allele frequencies were 3.3% for homozygous, 20% for heterozygous and as total 23.4%. The patients with H63D mutation had normal serum and tissue iron parameters. There was no statistically significant relationship between H63D mutation and histopathological findings. Two hour blood sugar levels were higher in Stage patients than in Stage patients (p=0.05), and also higher in Class patients than in Class S3 patients (p=0.05). Conclusion: The H63D mutation did not affected either serum iron parameters or histopathology. However, the insulin resistance was related with fibrosis in non-alcoholic steatohepatitis patients. Amaç: Bu çalışmada alkole bağlı olmayan steatohepatit (NASH) tanısı olan hastalarda H63D mutasyonunun demir yüklenmesi ve karaciğer hasarı üzerindeki etkisi; insülin direnci ve metabolik sendrom ile ilişkisi araştırıldı. Yöntem ve Gereçler: Hacettepe Üniversitesi, Gastroenteroloji polikliniğinde klinik ve laboratuar olarak NASH tanısı alan 32 hasta çalışmaya alındı. Hastalar metabolik sendrom açısından sorgulandı. Bel kalça oranı ve vücut kitle indeksleri hesaplandı. H63D gen mutasyonu, serum ve karaciğer dokusunda demir parametreleri ve boyanması; karaciğer histopatolojik özellikleri incelendi. İnsülin direnci ve metabolik sendrom ile ilişkili olarak açlık ve tokluk kan şekeri, lipid profili, 75-gr oral glukoz tolerans testi ve HOMA insulin direnci hesaplaması yapıldı. Sonuç: Ortalama vücut--kitle indeksi (VKİ) 28,1i33 kg/m2 olan 32 hasta çalışmaya alındı. Hipertansiyon (%25), obezite (%37), hiperkolesterolemi (%56), hipertrigliseridemi (%28) ve insülin direnci (%39) oldukça sıktı. İki hasta hariç tüm hastaların ferritin ve transferrin saturasyonu normaldi. Hastaların %41'inde HIC 1600 ug/g'ın üzerinde saptandı. H63D mutasyonu 12 (%40) hastada heterezigot, (%3) hastada ise homozigot saptandı. NASH hastalarında H63D alel frekansı %23,4 idi (%3,3 homozigot, %20 heterozigot). H63D mutasyonu olan hastalarda serum ve doku demir belirteçleri normal idi. H63D mutasyonu ile histopatolojik bulgular arasında ilişki saptanmadı. 2. saat kan şekeri ölçümü evre fibrozisi olan hastalarda evre olan hastalara göre, sınıf hastalarında sınıf s3 olan hastalara göre istatistiksel olarak yüksek saptandı. Sonuç: H63D mutasyonunun serum demir belirteçlerine veya histopatolojiye etkisi saptanmadı. Bununla birlikte non--alkolik steatohepatit hastalarında insülin direnci fibrosis ile iliskili bulundu.

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Background and aim: the objective of the present study was to investigate the prevalence of metabolic-associated fatty liver disease (MAFLD) in patients with dyspepsia. Materials and methods: a total of 909 consecutive patients who presented with dyspepsia at 8 tertiary care centers in Turkey between March 2019 and December 2019 were included. Results: the median age was 47 years. Among them, 30.3% of the patients were obese, 18.8% had type 2 diabetes mellitus (T2DM), 35.1% had metabolic syndrome, 84.8% had dyslipidemia, and 23.9% had hypertension. The prevalence of MAFLD was 45.5%. Among the patients with MAFLD, the prevalence of obesity, T2DM, metabolic syndrome, dyslipidemia, and hypertension was 43.3%, 24.9%, 52.5%, 92.3%, and 31.9%, respectively. MAFLD was significantly associated with all of the metabolic comorbidities (p, Turkish Association for the Study of the Liver and Fatty Liver Diseases Special Interest Groups

The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t)ide analogs after liver transplantation., NA