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BACKGROUND Non-invasive tests (NITs), such as Fibrosis-4 index (FIB-4) and the aspartate aminotransferase-to-platelet ratio index (APRI), developed using classical statistical methods, are increasingly used for determining liver fibrosis stages and recommended in treatment guidelines replacing the liver biopsy. Application of conventional cutoffs of FIB-4 and APRI resulted in high rates of misclassification of fibrosis stages. AIM There is an unmet need for more accurate NITs that can overcome the limitations of FIB-4 and APRI. PATIENTS AND METHODS Machine learning with the random forest algorithm was used to develop a non-invasive index using retrospective data of 7238 patients with biopsy-proven chronic hepatitis C from two centers in Egypt; derivation dataset (n = 1821) and validation set in the second center (n = 5417). Receiver operator curve analysis was used to define cutoffs for different stages of fibrosis. Performance of the new score was externally validated in cohorts from two other sites in Egypt (n = 560) and seven different countries (n = 1317). Fibrosis stages were determined using the METAVIR score. Results were also compared with three established tools (FIB-4, APRI, and the aspartate aminotransferase-to-alanine aminotransferase ratio [AAR]). RESULTS Age in addition to readily available laboratory parameters such as aspartate, and alanine aminotransferases, alkaline phosphatase, albumin (g/dl), and platelet count (/cm3 ) correlated with the biopsy-derived stage of liver fibrosis in the derivation cohort and were used to construct the model for predicting the fibrosis stage by applying the random forest algorithm, resulting in an FIB-6 index, which can be calculated easily at http://fib6.elriah.info. Application of the cutoff values derived from the derivation group on the validation groups yielded very good performance in ruling out cirrhosis (negative predictive value [NPV] = 97.7%), compensated advance liver disease (NPV = 90.2%), and significant fibrosis (NPV = 65.7%). In the external validation groups from different countries, FIB-6 demonstrated higher sensitivity and NPV than FIB-4, APRI, and AAR. CONCLUSION FIB-6 score is a non-invasive, simple, and accurate test for ruling out liver cirrhosis and compensated advance liver disease in patients with chronic hepatitis C and performs better than APRI, FIB-4, and AAR.

Background: To date, several researchers have investigated the association between dietary fibre consumption and satiety. However, there is no study that includes both inulin and β-glucan to compare energy intake (EI) and satiety ratings. Aim: The current study investigated the effects of two dietary fibres, β-glucan and inulin, on satiety and food intake. Methods: The study was carried out among 24 woman over 18 years of age. The dietary fibres β-glucan (6 g/day) or inulin (6 g/day) were consumed by participants for five weeks. On the first and fifth week visits, the participants consumed a standard breakfast followed by an ad libitum test meal. Appetite was assessed using visual analogue scales (VAS) before and after breakfast. EI was measured at the test meal using plate waste. Results: Both dietary fibres significantly reduced the VAS scores of hunger, prospective food consumption and desire to eat, and increased satiety compared with the control group. However, the area under curve data for the VAS scores did not exhibit a significant difference. Significant reductions in EI and anthropometric values between the first and fifth week measures were observed in both dietary fibre groups. Statistically significant changes occurred in the body weight [-1.25 (1.27) kg], body mass index [-0.41 (0.42) kg/m2], waist circumference [-1.25 (1.04) cm] and waist/hip ratio [-0.01(0.01)] in the β-glucan group, whereas a statistically significant change occurred in body fat percentage in the inulin group [-2.16% (7.49)]. Conclusions: Overall, these findings demonstrate that the participants consuming β-glucan over the course of the five weeks had less EI, felt less hunger and had more satiety.

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.

Aim: To present results of percutaneous treatment with Örmeci technique for muscle hydatid diseases. Material and Method: Twelve patients (9 male, 3 female) with 16 hydatid cysts (10 CE Type 1, 6 CE Type3B) were treated by percutaneous treatment with Örmeci technique. The percutaneous puncture was performed under sonographic guidance using a 22-gauge Chiba needle as a one-step procedure in CE type 1 and 3A. However, two to six Chiba needles according to size of the cysts were used in different locations at the same time in the cyst of CE type 2, and 3B). For every 1 cm of the long diameter of the cyst lesion, 3cc of fluid from the cysts was aspirated, which was almost the same amount of cc in volume for the CE type 1 and CE type 3A hydatid cysts. A 2cc of pure alcohol (96 %) and 1cc of polidocanol 1% (ethoxysclerol 1%, Kreussler Pharma, Wiesbaden, Germany) were injected into the cysts right after the aspiration of CE type 1 and type 3A, without the aspiration of CE type 2 and 3B, for each centimeter of the long diameter of the cysts. The total amount of pure alcohol and polidocanol were injected equally among the CE type 2 and type 3B cyst’s needles. It was waited for five minutes for all scolexes to be killed and the needle/or needles were taken back. The patients with hydatid disease were followed up mean 34.75 ±14.39 (maximum 65-minimum 15) months. Findings: Fifteen out of 16 hydatid cysts (93.75%) cured. We had two complications of treatment. One patient had an abscess in the cyst after the percutaneous treatment. After the percutaneous drainage, patient was cured well, and he had no symptoms during the follow up. Another patient had torpidity in his leg after the treatment. After three months, he had no symptoms. In Conclusion, Percutaneous treatment with Örmeci technique is outpatient based, successful, safe, repeatable, cheap and It can be used as an alternative treatment in selected patients.

The hepatic venous pressure gradient (HVPG) is the gold standard for cirrhotic portal hypertension (PHT), but it is invasive and specialized. Alternative non-invasive techniques are needed to assess the hepatic venous pressure gradient (HVPG). Here, we develop an auto-machine-learning CT radiomics HVPG quantitative model (aHVPG), and then we validate the model in internal and external test datasets by the area under the receiver operating characteristic curves (AUCs) for HVPG stages (≥10, ≥12, ≥16, and ≥20 mm Hg) and compare the model with imaging- and serum-based tools. The final aHVPG model achieves AUCs over 0.80 and outperforms other non-invasive tools for assessing HVPG. The model shows performance improvement in identifying the severity of PHT, which may help non-invasive HVPG primary prophylaxis when transjugular HVPG measurements are not available.

Owing to impaired immune function, surgical procedures, and multiple hospitalizations, patients with end-stage liver disease are at risk for numerous infectious complications while waiting for transplantation. Infection in transplant recipients remains the main cause of mortality and morbidity, despite advances in surgical techniques and the development of new repressive agents. The purpose of this study is to examine the infections that develop during the pretransplantion period in live donor liver transplant recipients and their effect on post-transplant clinical outcomes. The retrospective analysis of adult live donor liver transplant recipients in the last 4 years was conducted at Ankara University Hospital, a 1900-bed tertiary-care university hospital, in Ankara, Turkey. Demographic characteristics, preoperative infections, and clinical outcomes were analyzed. Patients were divided into 2 groups according to whether they had developed an infection before transplantation. The diagnoses were based on clinical, laboratory, and microbiological findings. Statistical analyses were performed using Stata version 9.0 (StataCorp, College Station, Tex., United States), and P In univariate analyses, having diabetes mellitus or a pretransplant infection, the number of pretransplant infection attacks, the need for a reoperation, and developing a post-transplant infection were the statistically significant factors associated with 1-year mortality (P Our study showed the effect of pretransplantation infections on post-transplant morbidity but not on rejection or mortality. According to the situation of patients, manageable pretransplantation infection is not an absolute contraindication for liver transplantation. Awareness of the increased risk for post-transplant infections and fast-acting antimicrobial coverage are the most important facts for patient survival.

INTRODUCTION Both hepatitis C virus infection (HCV) and chronic kidney disease (CKD) have been comorbid illnesses with increasing morbidity and mortality. The present study was conducted to present real-life experiences about treatment of HCV and CKD with a fixed-dose combination of paritaprevir 150 mg/day, ritonavir 100 mg/day as a booster, ombitasvir 25 mg/day, and dasabuvir 250 mg twice/day, the PROD regimen. PATIENTS AND METHODS This was a multicenter, retrospective cohort study. Seventy-five patients with both HCV and CKD were treated with a PROD-based regimen with or without ribavirin. Fifty-three of 75 patients were on maintenance hemodialysis program. Seven patients had compensated liver cirrhosis. The patients with genotype 1a or compensated liver cirrhosis were treated with the PROD regimen and ribavirin in a dose of 200 mg every other day for 12 weeks. The patients with genotype 1b were treated with PROD for 12 weeks. The patients with genotype 4 were treated with a combination of paritaprevir, ritonavir, ombitasvir, and ribavirin 200 mg every other day. RESULTS All patients except one were HCV-RNA negative (98.6%) at the end of treatment. One patient had decompensated after the fourth day of therapy. She stopped the treatment, and she was exitus after 2 months. Two patients died of reasons not related to the drugs 2 months after negativity of HCV-RNA. Sustained viral rate 12 weeks after treatment was found in 96% of the patients. CONCLUSION The PROD regimen was very effective and safe for treatment in patients with HCV and CKD who were in stages 4 and 5.

Background and Aims This study aimed to determine the performance of the non-invasive score using noncontrast-enhanced MRI (CHESS-DIS score) for detecting portal hypertension in cirrhosis. Methods In this international multicenter, diagnostic study (ClinicalTrials.gov, NCT03766880), patients with cirrhosis who had hepatic venous pressure gradient (HVPG) measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China (n=4) and Turkey (n=1) between December 2018 and April 2019. A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017. After segmentation of the liver on fat-suppressed T1-weighted MRI maps, CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity. Results A total of 149 patients were included, of which 124 were from four Chinese hospitals (training cohort) and 25 were from two international hospitals (validation cohort). A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36 (p, Graphical abstract

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries’ progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100000, reduce HBV prevalence among 1-year-olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100000, and demonstrate HBV and HCV year-to-year decrease in new HCV- and HBV-related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.

Background: We developed and validated a noninvasive diagnostic index based on routine laboratory parameters for predicting the stage of hepatic fibrosis in patients with chronic hepatitis C (HCV). Patients and Methods: Machine learning with random forests algorithm was used to develop a noninvasive index using retrospective data of 7238 biopsy-proven chronic hepatitis C (CHC) patients from two centers; derivation dataset (n=1821) and validation set in the second center (n=5417). ROC curve analysis was used to define cutoffs for different stages of fibrosis. Performance of the new score was externally validated in cohorts from two other sites in Egypt (n=560) and seven different countries (n=1317). Results were also compared with three established tools (FIB-4, APRI, and AAR). Results: Age, aspartate, and alanine aminotransferases, alkaline phosphatase, albumin (g/dL), and platelet count (/cm3) correlated with the biopsy-derived stage of liver fibrosis in the derivation cohort and were used to construct the model for predicting the fibrosis stage, resulting in a FIB-6 index. Applying the cutoffs from the ROC curve analysis of the derivation group in the validation groups indicated very good performance in ruling out cirrhosis (negative predictive value [NPV] = 97.7%), severe fibrosis (NPV = 90.2%), and significant fibrosis (NPV = 65.7%). In the external validation groups, FIB-6 demonstrated higher sensitivity and NPV than FIB-4, APRI, and AAR. Conclusion: FIB-6 score is an accurate, simple, non-invasive test for ruling out advanced fibrosis and liver cirrhosis in chronic hepatitis C patients and performs better than APRI, FIB-4, and AAR. Funding Statement: Public donations for ELRIAH. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study protocol was approved by the Research and Ethics Committee of ELRIAH (OHRP IRB #8819). The protocol and conduct of the study complied with the International Ethical Guidelines for Biomedical Research Involving Human Subjects [28] and its amendments in 2008. The requirement for written informed consent was waived by the ethics committee as this was a retrospective analysis of anonymized patient data collected during routine clinical care.

Three-dimensional (3D) visualization involves feature extraction and 3D reconstruction of CT images using a computer processing technology. It is a tool for displaying, describing, and interpreting 3D anatomy and morphological features of organs, thus providing intuitive, stereoscopic, and accurate methods for clinical decision-making. It has played an increasingly significant role in the diagnosis and management of liver diseases. Over the last decade, it has been proven safe and effective to use 3D simulation software for pre-hepatectomy assessment, virtual hepatectomy, and measurement of liver volumes in blood flow areas of the portal vein; meanwhile, the use of 3D models in combination with hydrodynamic analysis has become a novel non-invasive method for diagnosis and detection of portal hypertension. We herein describe the progress of research on 3D visualization, its workflow, current situation, challenges, opportunities, and its capacity to improve clinical decision-making, emphasizing its utility for patients with liver diseases. Current advances in modern imaging technologies have promised a further increase in diagnostic efficacy of liver diseases. For example, complex internal anatomy of the liver and detailed morphological features of liver lesions can be reflected from CT-based 3D models. A meta-analysis reported that the application of 3D visualization technology in the diagnosis and management of primary hepatocellular carcinoma has significant or extremely significant differences over the control group in terms of intraoperative blood loss, postoperative complications, recovery of postoperative liver function, operation time, hospitalization time, and tumor recurrence on short-term follow-up. However, the acquisition of high-quality CT images and the use of these images for 3D visualization processing lack a unified standard, quality control system, and homogeneity, which might hinder the evaluation of application efficacy in different clinical centers, causing enormous inconvenience to clinical practice and scientific research. Therefore, rigorous operating guidelines and quality control systems need to be established for 3D visualization of liver to develop it to become a mature technology. Herein, we provide recommendations for the research on diagnosis and management of 3D visualization in liver diseases to meet this urgent need in this research field.

With the increasing prevalence of obesity and type 2 diabetes, fatty liver disease associated with metabolic dysfunction is a global health problem, especially because it is one of the earliest consequences of obesity and it precedes diabetes development. Fatty liver disease associated with metabolic dysfunction is of particular concern in the Middle East and north Africa, where its prevalence is greater than that in the rest of the world. Despite the magnitude of the problem, no regional guidelines have been developed to address this disease. This Review describes suggestions of redefining fatty liver disease associated with metabolic dysfunction, including its terminology and criteria for diagnosis. Experts have raised serious concerns on the current nomenclature, which labels the disease as non-alcoholic fatty liver disease (NAFLD), and its diagnostic criteria. The panel reached a consensus that the disease should be renamed as metabolic-associated fatty liver disease (MAFLD) and that the disease should be diagnosed by positive criteria. The aim is now to work with authorities across the region to implement these proposed changes and reflect them in health-care policy and to improve health care for patients in this region.

Background in 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. Methods Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. the infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. Results At the beginning of 2017, 271,000 viremic infections were estimated. of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10-25%. in the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45-70%. in the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80-85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. Conclusions To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs., Gilead SciencesGilead Sciences, This publication has been supported by Gilead Sciences with financial support for some editorial services and administrative support to facilitate and coordinate the publication by arranging meetings. the funding body had no role in the study design, data collection, analysis, interpretation of data or in the writing of the manuscript. the content of the publication reflects the independent opinions of the authors and Gilead did not have any influence or control.

Objective: This study aimed to determine the performance of the non-invasive score using non-contrast-enhanced MRI (CHESS-DIS score) for detecting portal hypertension in cirrhosis. Methods: In this multicentre, diagnostic study (ClinicalTrials.gov, NCT03766880), patients with cirrhosis who had hepatic venous pressure gradient (HVPG) measurement and non-contrast-enhanced MRI were prospectively recruited from five university hospitals in China (n=4) and Turkey (n=1) between December 2018 and April 2019. Besides, a cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017 to validate the proposed score. After segmentation of the liver on fat- suppressed T1-weighted MRI maps, CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity. Results: A total of 149 patients were included, of which 124 were from four Chinese hospitals (training cohort) and 25 were from two international hospitals (validation cohort). A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0·36 (p < 0·0001) and 0·55 ( p < 0·01) for the training and validation cohorts, respectively. The area under the receiver operating characteristic curve of CHESS-DIS score in detection of CSPH were 0·81 and 0·9 in the training and validation cohorts, respectively. The intraclass correlation coefficients for assessing the inter- and intra-observer agreement were 0·846 and 0·841, respectively. Conclusions: A non-invasive score using non-contrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG. Besides, it could be used to detect CSPH in patients with cirrhosis. Trial Registration: ClinicalTrials.gov, NCT03766880 Funding Statement: This investigator-initiated trial received no commercial support and has been supported by the grants from National Natural Science Foundation for Distinguished Young Scholars of China (81525014); National Natural Science Foundation of China (81830053); Guangzhou Industry-Academia-Research Collaborative Innovation Major Project (201704020015); President Foundation of Nanfang Hospital, Southern Medical University (2017Z012). Declaration of Interests: None declared. Ethics Approval Statement: This study was performed according to Helsinki declaration with approval by all institutional review boards.

Background/aims Hydatid disease remains an important global socioeconomic health problem, particularly in the endemic areas. Although half of the patients show no symptoms, hydatid cysts should be treated because of their fatal complications. The aim of this study is to present the long-term results of percutaneous treatment of hydatid disease using the Ormeci technique. Materials and methods Forty-nine patients with 54 cystic lesions were diagnosed with hydatid disease. Twenty-seven of the 54 hydatid cysts located in the spleen were punctured with a 22-gauge Chiba needle through the parenchyma of the spleen under sonographic guidance as a one-step procedure. For every 1 cm of the long diameter of the cyst lesion, 3 cc of fluid from the cysts was aspirated. For each centimeter of the long diameter, 2 cc of pure alcohol (96%) and 1 cc of polidocanol (1%) were injected into the cysts. Five out of 27 patients did not participate in the follow-up. Results The 22 patients who were treated using the percutaneous Ormeci technique were followed up for a mean±SD (median) of 50.32±65.30 (26.00) months (minimum 4 and maximum 298 months). All patients except one were successfully treated. No deaths or major complications were noted. Seven patients experienced minor complications. Conclusion Percutaneous treatment with the Ormeci technique is a safe, effective, cheap, and reliable method that does not interfere with splenic functions, and this outpatient procedure should be the method of choice for a surgery alternative.

Data are relatively scarce on gastro-intestinal tuberculosis (GITB). Most studies are old and from single centers, or did not include immunosuppressed patients. Thus, we aimed to determine the clinical, radiological, and laboratory profiles of GITB. We included adults with proven GITB treated between 2000 and 2018. Patients were enrolled from 21 referral centers in 8 countries (Belgium, Egypt, France, Italy, Kazakhstan, Saudi Arabia, UK, and Turkey). One hundred four patients were included. Terminal ileum (n = 46, 44.2%), small intestines except terminal ileum (n = 36, 34.6%), colon (n = 29, 27.8%), stomach (n = 6, 5.7%), and perianal (one patient) were the sites of GITB. One-third of all patients were immunosuppressed. Sixteen patients had diabetes, 8 had chronic renal failure, 5 were HIV positive, 4 had liver cirrhosis, and 3 had malignancies. Intestinal biopsy samples were cultured in 75 cases (78.1%) and TB was isolated in 65 patients (86.6%). PCR were performed to 37 (35.6%) biopsy samples and of these, 35 (94.6%) were positive. Ascites samples were cultured in 19 patients and M. tuberculosis was isolated in 11 (57.9%). Upper gastrointestinal endoscopy was performed to 40 patients (38.5%) and colonoscopy in 74 (71.1%). Surgical interventions were frequently the source of diagnostic samples (25 laparoscopy/20 laparotomy, n = 45, 43.3%). Patients were treated with standard and second-line anti-TB medications. Ultimately, 4 (3.8%) patients died and 2 (1.9%) cases relapsed. There was a high incidence of underlying immunosuppression in GITB patients. A high degree of clinical suspicion is necessary to initiate appropriate and timely diagnostic procedures; many patients are first diagnosed at surgery., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction: In this study, it was aimed to evaluate factors associated with hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) positivity through the "Raising Public Awareness and Determining Epidemiological Changes in Hepatitis" project conducted by the Viral Hepatitis Society of Turkey. Materials and Methods: A total of 61,943 participants (mean age 35±14.1 years, 50.8% males) who volunteered to participate in the study were screened for HBsAg and anti-HCV by primary healthcare centers distributed throughout 78 cities in Turkey. A standard questionnaire form about sociodemographic features and transmission-related risk factors was completed via face-to-face interviews with each participant. A sub-population of 21,473 participants with complete data were analyzed for the presence of risk factors associated with HBsAg and anti-HCV seropositivity. Results: HBsAg and anti-HCV seropositivity were detected in 1,515 (2.5%) and 332 (0.6%) of the 61,943 study population, respectively. By univariate chi-square test, significant associations were found between hospitalization and anti-HCV and between dental treatment in the last five years and HBsAg and anti-HCV seropositivity. In multivariate logistic regression analysis, dental treatment was still associated with HBsAg and anti-HCV seropositivity, while hospitalization was associated with anti-HCV seropositivity. Conclusion: In conclusion, our findings indicate dialysis and history of hospitalization impose significant risks for hepatitis C transmission, and dental treatment is associated with transmission of both hepatitis B and hepatitis C.

Carbapenemase-producing Enterobacteriacea (CPE) cause serious and life-threatening infections. They are resistant to carbapenems and many other classes of commonly used antimicrobial agents; therefore, managing infections caused by them poses a substantial challenge in clinical practice. They can also cause morbidity and mortality in patients with liver transplant. A retrospective analysis of CPE culture-positive patients with a history of liver transplant can help to examine the epidemiology and microbiology of these bacteria, as well as gain information on the possible infection sources, susceptibility patterns, and expected mortality in infected populations. In addition, study of these bacteria could help formulate a consensus on the appropriate use of empirical and directed antibiotic therapy, which can effectively reduce infections in these patients. We reviewed the medical records of 142 subjects who underwent liver transplantation at Ankara University Hospital, a 1900-bed tertiary care university hospital, in Ankara, Turkey, between January 2014 and August 2018. Patients showing signs of infection with culture positivity for CPE-producing organisms were included from the study. Statistical analysis was performed and a value of P .05 is considered statistically significant. In most cases, the source of infection was the abdomen. Klebsiella species was also predominant in these cases. Model for End-Stage Liver Disease scores and length of hospital stay were higher and statistically significant when compared to patients who were CPE negative. Mortality was highest in the CPE-positive group. Infection is the most important cause of mortality and morbidity after liver transplantation and increases the cost of treatment. Regarding the culture sensitivity patterns and resistance mode, empirical therapy with carbapenems does not produce a solid result. The high mortality observed with these infections reflects very limited therapeutic options.

Introduction Several markers of systemic inflammation, including blood C-reactive protein, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) have been identified as independent prognosticators for hepatocellular carcinoma (HCC). Methods To attempt to understand the significance of these markers, they were examined in relation to 4 tumour parameters, namely maximum tumour diameter (MTD), tumour multifocality, portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels. Results Using linear and logistic regression models, we found that C-reactive protein and PLR on single variables, were statistically significantly related to the tumour parameters. In a logistic regression final model, CRP was significantly related to MTD, AFP and PVT, and the Glasgow Index significantly related to MTD and AFP. Results of the area under the receiver operating characteristic curves (ROC), showed that the areas for PLR and CRP were statistically significant for high versus low MTD and for presence versus absence of PVT. CRP alone was significant for high versus low AFP. Conclusions These analyses suggest that the prognostic usefulness of the inflammatory markers PLR and CRP (but not NLR) may be due to their reflection of parameter values for tumour growth and invasiveness.

Introduction Periampullary diverticula (PD) is caused by extraluminal pouching of duodenal mucosa. Using a very common endoscopic procedure to diagnose or treat gastrointestinal disorders, we encountered duodenal diverticulum. Materials and methods This is a retrospective, single-center study. Three thousand and sixteen patients on whom endoscopic retrograde cholangiopancreatography (ERCP) was performed at Ankara University Medical School, Department of Gastroenterology, from June 2009 to June 2014 were included to the study. Results Hundred and thirty patients (males 65, females 65) among the 3,016 had PD. Two hundred and sixty patients without diverticulum were randomly chosen from the 3,016 patients, as a control group [121 (47%) females, 139 (53%) males]. There was no statistical difference between the two groups. The mean age of the patients with PD was 69.9 years, while the mean age was 62.3 years for patients without PD (p < 0.001). Incidence for PD was 4.6%. The papilla of Vater was located in the inter-diverticular area (Type 1) in 9 patients (8.3%), at the edge of the diverticulum (Type 2) in 31 patients (28.4%), and at a distance of 2 to 3 cm from the papilla (Type 3) in 69 patients (63.3%). Discussion Although numerically more common bile duct stones occurred in patients with PD compared to those without PD, there was no statistical difference between the two groups. The rate of pancreato-biliary carcinomas was higher in patients without diverticulum. Cannulation was successful in both groups at the rate of 97.6 and 92% respectively, but cannulation failed more often in patients without PD. Duodenal perforation occurred in one patient with PD. Bleeding after sphincterotomy occurred in two patients without PD. How to cite this article Örmeci N, Deda X, Kalkan Ç, Tüzün AE, Karakaya F, Dökmeci A, Bahar DK, Özkan H, İdilman R, Çınar K. Impact of Periampullary Diverticula on Bile Duct Stones and Ampullary Carcinoma. Euroasian J Hepato-Gastroenterol 2016;6(1):31-34.

OZ Objective: The study was designed to evaluate the relationship between the methods of circumcision procedures used in the past and hepatitis B surface antigen (HBsAg), anti-HBs and anti-hepatitis C virus (HCV) positivity. Materials and Methods: Within the scope of “Public Hepatitis Awareness Activities” executed by the Viral Hepatitis Society, volunteer participants who were admitted to primary healthcare centers across the Turkey, were screened for HBsAg, anti-HBs and anti-HCV positivity. A standard questionnaire form regarding their circumcision procedure in the past was applied via face-to-face interview method to each participant while their blood samples were collected for the analysis of hepatitis B virus and HCV positivity. Results: HBsAg, anti-HBs and anti-HCV positivity rates were 3.6%, 9.9% and 0.6% respectively. HBsAg positivity was significantly higher in group of participants who have been circumcised by a traditional non-medical person than in the other group of subjects who have been circumcised by a health professional (3.3% vs 5.3%, p=0.003). Conclusion: Circumcision is a widespread practice based on the existing cultural and religious traditions in islamic countries like Turkey. Mass circumcision and circumcision performed by traditional nonmedical persons like barbers is still one of the important health-care problems with the risk of transmission of viral infections in Turkey. The results will help to take measures for preventing viral hepatitis transmission.

Background & Aims Noninvasive and accurate methods are needed to identify patients with clinically significant portal hypertension (CSPH). We investigated the ability of deep convolutional neural network (CNN) analysis of computed tomography (CT) or magnetic resonance (MR) to identify patients with CSPH. Methods We collected liver and spleen images from patients who underwent contrast-enhanced CT or MR analysis within 14 days of transjugular catheterization for hepatic venous pressure gradient measurement. The CT cohort comprised participants with cirrhosis in the CHESS1701 study, performed at 4 university hospitals in China from August 2016 through September 2017. The MR cohort comprised participants with cirrhosis in the CHESS1802 study, performed at 8 university hospitals in China and 1 in Turkey from December 2018 through April 2019. Patients with CSPH were identified as those with a hepatic venous pressure gradient of 10 mm Hg or higher. In total, we analyzed 10,014 liver images and 899 spleen images collected from 679 participants who underwent CT analysis, and 45,554 liver and spleen images from 271 participants who underwent MR analysis. For each cohort, participants were shuffled and then sampled randomly and equiprobably for 6 times into training, validation, and test data sets (ratio, 3:1:1). Therefore, a total of 6 deep CNN models for each cohort were developed for identification of CSPH. Results The CT-based CNN analysis identified patients with CSPH with an area under the receiver operating characteristic curve (AUC) value of 0.998 in the training set (95% CI, 0.996–1.000), an AUC of 0.912 in the validation set (95% CI, 0.854–0.971), and an AUC of 0.933 (95% CI, 0.883–0.984) in the test data sets. The MR-based CNN analysis identified patients with CSPH with an AUC of 1.000 in the training set (95% CI, 0.999–1.000), an AUC of 0.924 in the validation set (95% CI, 0.833–1.000), and an AUC of 0.940 in the test data set (95% CI, 0.880–0.999). When the model development procedures were repeated 6 times, AUC values for all CNN analyses were 0.888 or greater, with no significant differences between rounds (P > .05). Conclusions We developed a deep CNN to analyze CT or MR images of liver and spleen from patients with cirrhosis that identifies patients with CSPH with an AUC value of 0.9. This provides a noninvasive and rapid method for detection of CSPH ( ClincialTrials.gov numbers: NCT03138915 and NCT03766880 ).

PubMed: 29599078, 2-s2.0-85044540918, Background: The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. Although no virological cure exists for hepatitis B virus (HBV) infection, existing therapies to control viral replication and prophylaxis to minimise mother-to-child transmission make elimination of HBV feasible. We aimed to estimate the national, regional, and global prevalence of HBsAg in the general population and in the population aged 5 years in 2016, as well as coverage of prophylaxis, diagnosis, and treatment. Methods: In this modelling study, we used a Delphi process that included a literature review in PubMed and Embase, followed by interviews with experts, to quantify the historical epidemiology of HBV infection. We then used a dynamic HBV transmission and progression model to estimate the country-level and regional-level prevalence of HBsAg in 2016 and the effect of prophylaxis and treatment on disease burden. Findings: We developed models for 120 countries, 78 of which were populated with data approved by experts. Using these models, we estimated that the global prevalence of HBsAg in 2016 was 3·9% (95% uncertainty interval [UI] 3·4–4·6), corresponding to 291 992 000 (251 513 000–341 114 000) infections. Of these infections, around 29 million (10%) were diagnosed, and only 4·8 million (5%) of 94 million individuals eligible for treatment actually received antiviral therapy. Around 1·8 (1·6–2·2) million infections were in children aged 5 years, with a prevalence of 1·4% (1·2–1·6). We estimated that 87% of infants had received the three-dose HBV vaccination in the first year of life, 46% had received timely birth-dose vaccination, and 13% had received hepatitis B immunoglobulin along with the full vaccination regimen. Less than 1% of mothers with a high viral load had received antiviral therapy to reduce mother-to-child transmission. Interpretation: Our estimate of HBV prevalence in 2016 differs from previous studies, potentially because we took into account the effect of infant prophylaxis and early childhood vaccination, as well as changing prevalence over time. Although some regions are well on their way to meeting prophylaxis and prevalence targets, all regions must substantially scale-up access to diagnosis and treatment to meet the global targets. Funding: John C Martin Foundation. © 2018 Elsevier Ltd, H28-kansei-ippan-001 National Academy of Sciences, NAS Novartis Roche World Health Organization, WHO Gilead Sciences Alnylam Pharmaceuticals AbbVie Meso Scale Diagnostics, MSD British Microcirculation Society, BMS Japan Society for the Promotion of Science, JSPS: 17H03589 Ministry of Health, Labour and Welfare, MHLW Vetenskapsrådet, VR Siemens Universiteit Antwerpen OLL-683801, DR-S, IGa, SB, SMB, CE, KM, HMN, KP, KR-S, SR, JDS, and HR report grants from John C Martin Foundation, during the conduct of the study, and grants from Gilead Sciences, AbbVie, WHO, National Academy of Sciences, Intercept Pharmaceuticals, and Boehringer Ingelheim, outside the submitted work. MHN reports grants and personal fees from Bristol-Myers Squibb (BMS), Gilead Sciences, and Janssen, and personal fees from Novartis, Anylam, and Dynavax, outside the submitted work. PVD acts as chief and principal investigator for vaccine trials done on behalf of the University of Antwerp, Belgium, for which the University obtains research grants from vaccine manufacturers; speaker's fees for presentations on vaccines are paid directly to an educational fund held by the University of Antwerp, and PVD receives no personal remuneration for this work. ACA reports personal fees from Mylan Pharmaceuticals, outside the submitted work. JEA reports fees paid to his hospital for participation on the advisory boards of Gilead Sciences, ViiV Healthcare, BMS, Janssen, and AbbVie, and grants from BMS, Merck Sharp & Dohme (MSD), AbbVie, and ViiV Healthcare, outside the submitted work. TB reports grants, personal fees, and non-financial support from AbbVie and Gilead Sciences; grants and personal fees from BMS, Janssen, Roche, MSD, and Sequana Medical; and personal fees from Bayer, Vertex, Tibotec, Intercept, Sirtex, and Alexion, outside the submitted work. PB reports grants and personal fees from AbbVie, Gilead Sciences, and MSD, outside the submitted work. MBr reports personal fees from BMS, Gilead Sciences, and Janssen, and grants from BMS, outside the submitted work. HLYC reports personal fees from Gilead Sciences, BMS, AbbVie, Roche, MedImmune, and Intellia, outside the submitted work. PBC reports grants from AbbVie, Gilead Sciences, and MSD, outside the submitted work. VC reports personal fees from AbbVie, BMS, Gilead Sciences, and MSD, and grants from BMS, outside the submitted work. MCor reports personal fees from AbbVie, BMS, Boehringer Ingelheim, Biogen Idec, Falk Foundation, Gilead Sciences, Janssen, MSD, Roche Diagnostics, Roche Pharma, and Siemens, outside the submitted work. SD and PJ report personal fees and non-financial support from AbbVie and Gilead Sciences, and personal fees from MSD, outside the submitted work. MHE-S is an advisory board member for Perspectum Diagnostics, and reports grants and non-financial support from Gilead Sciences, and non-financial support from AbbVie and Quadri Pharma, outside the submitted work. RF reports grants, personal fees, and non-financial support from Roche and Gilead Sciences, and personal fees and non-financial support from BMS, outside the submitted work. GBG reports grants and personal fees from Gilead Sciences, outside the submitted work. JG-S reports grants and personal fees from Gilead Sciences, and personal fees from MSD, Abbvie, Janssen, and BMS, outside the submitted work. JGer reports grants and personal fees from AbbVie, Gilead Sciences, Janssen, MSD, BMS, and ViiV Healthcare, outside the submitted work. RG reports grants from New South Wales Ministry of Health and provided project advice regarding viral hepatitis treatment to Gilead Sciences, outside the submitted work. AHa reports unrestricted grants from AbbVie, MSD, Gilead Sciences, BMS, and Novartis, and non-financial support from Gilead Sciences, outside the submitted work; he was also on advisory boards for AbbVie, Gilead Sciences, and BMS. CH reports personal fees from AbbVie, BMS, Gilead Sciences, Janssen, and MSD, outside the submitted work. JJ reports personal fees and non-financial support from Gilead Sciences and AbbVie, and personal fees from Roche and BMS, outside the submitted work. MK reports grants from Roche, Siemens, Hologic, and Boerhinger Ingleheim, outside the submitted work. JVL reports grants and personal fees from Gilead Sciences and personal fees from Cepheid, outside the submitted work. MMan reports personal fees from Roche, BMS, GlaxoSmithKline, Aevi Genomic Medicine, ENYO Pharma, and CureVac, and grants and personal fees from Gilead Sciences and Novartis, outside the submitted work. SMau reports personal fees and non-financial support from Gilead Sciences and BMS, outside the submitted work. CM reports grants and personal fees from AbbVie, Gilead Sciences, and BMS; personal fees from MSD; and grants from Roche, outside the submitted work. BM reports grants and personal fees from Gilead Sciences and personal fees from AbbVie, MSD, BMS, Bayer, Intercept, and Sigma-Tau, during the conduct of the study. FN reports personal fees and non-financial support from Gilead Sciences, during the conduct of the study. AR reports grants and personal fees from AbbVie, Gilead, and MSD, and personal fees form BMS, Celgene, Janssen, Intercept, and Lupin, outside the submitted work. HWR reports grants and personal fees from AbbVie, BMS, Boehringer Ingelheim, ENYO Pharma, Gilead Sciences, Janssen, MSD, PRA Health Sciences, Regulus, and Roche; personal fees from Alnylam and R-Pharm; and grants from Replicor, outside the submitted work. LRR reports grants from the Center for Clinical and Translational Science and the Swedish Research Council (Ghana), during the conduct of the study. LRR also reports grants from Gilead Sciences, BTG, Ariad, and Wako, outside the submitted work, and was a consultant and advisory board member for Wako, Medscape, Axis, OncLive, Bayer, Tavec, and Grail. SDR has served as an advisory board member and speaker for Gilead Sciences, AbbVie, and MSD. OS has served as a consultant and on advisory boards for MSD; received research grants from AbbVie, BMS, MSD, Boehringer Ingelheim, R-Pharm, and Hepatera; and served as a speaker for Abbott, AbbVie, BMS, Gilead Sciences, Janssen, MSD, and R-Pharm. JFS-A reports personal fees from AbbVie and grants from Gilead Sciences and Janssen, outside the submitted work. CSa reports personal fees from Gilead Sciences and BMS, outside the submitted work. PS reports grants and personal fees from Gilead Sciences, AbbVie, and BMS, and personal fees from Intercept, outside the submitted work. CSt has consulted with and served on advisory boards for Gilead Sciences, AbbVie, and MSD. VSy reports grants and personal fees from Gilead Sciences, personal fees and non-financial support from AbbVie, and personal fees from Janssen, outside the submitted work. KT reports grants and personal fees from AbbVie, Gilead Sciences, and BMS; personal fees from MSD and Alfa Wasserman; and grants from Janssen, outside the submitted work. AJvdM reports grants and personal fees from Gilead Sciences and personal fees from AbbVie, outside the submitted work. IW reports personal fees from AbbVie, Gilead Sciences, Janssen, Marcyrl, Mylan, Onxio, and Pharco, outside the submitted work. NW reports personal fees paid to her department from AbbVie, BMS, Gilead Sciences, and MSD, outside the submitted work. VWW reports personal fees from Gilead Sciences, BMS, and MSD, outside the submitted work. M-FY was a speaker or advisory board member for AbbVie, BMS, Gilead Sciences, Roche, GlaxoSmithKline, Fujirebio, Biocartis, and MSD, outside the submitted work. SZ reports consultancy and lecture fees from AbbVie, Gilead Sciences, and MSD, and consultancy fees from Intercept, outside the submitted work. All other authors declare no competing interests., This study was funded by the John C Martin Foundation through the Polaris Observatory. We thank the Research on Hepatitis group (H28-kansei-ippan-001 and H25-kanen-ippan-010; led by JT), funded by the Ministry of Health, Labour and Welfare of Japan, for their provision of country-level data for Japan, and Örebro County Council for providing ALF grants (OLL-683801) to A-SD, which allowed collection of country-level data for Sweden.

EgeUn###, The hepatocellular carcinoma (HCC) tumor marker alpha-fetoprotein (AFP) is only elevated in about half of the HCC patients, limiting its usefulness in following the effects of therapy or screening. New markers are needed. It has been previously noted that the inflammation markers C-reactive protein (CRP) and platelet-lymphocyte ratio (PLR) are prognostically important and may reflect HCC aggressiveness. We therefore examined these 2 markers in a low-AFP HCC cohort and found that for HCCs > 2 cm, both markers significantly rise with an increasing maximum tumor diameter (MTD). We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden index value for each marker, and their area-under-the-curve values for each MTD group. Patients were dichotomized into 2 groups based on the CRP and PLR from the receiver-operating characteristic curve analysis. In the logistic regression models of the 4 different MTD patient groups, CRP and PLR levels were statistically significant to estimate MTD in univariate logistic regression models of MTD groups > 2 cm. CRP and PLR were then combined, and the combination was statistically significant to estimate MTD groups of 3-, 4-, and 5-cm cutoffs. CRP and PLR thus have potential as tumor markers for low-AFP HCC patients, and possibly for screening. (C) 2018 S. Karger AG, Basel, NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [CA 82723], This work was supported in part by the NIH grant CA 82723 (B.I.C).

This consensus report includes expert opinions and recommendations regarding the screening, and if necessary, the follow-up, prophylaxis, and treatment of hepatitis B before the treatment in patients who will undergo immunosuppressive therapy due to the risk of hepatitis B reactivation emergency. To increase awareness regarding the risk of hepatitis B reactivation in immunosuppressive patients, academicians from several university health research and training centers across Turkey came together and discussed the importance of the subject, current status, and issues in accordance with the current literature data and presented solutions.

HCV is an important global health and economic problem through direct and indirect medical cost associated with managing liver disease, decreased work productivity. A hundred eighty million people are infected in the world. HCV is associated with the increasing liver related and all causes of mortality. Both HCV and Chronic Kidney Disease (CKD) have a negative impact on both morbidity and mortality. The aim of this article is to reveal the close relationship between HCV and CKD, and to review the studies related with treatment of patients with HCV and different stages of CKD. Clinical use of Direct Antiviral Agents (DAAs) for the treatment in patients with HCV infection revolutionized the increase of sustained virological response (SVR), decreasing the duration of treatment and severe adverse events. Treatment of HCV infection in chronic renal impairment is reviewed in this article. In conclusion, the treatment with DAAs is effective more than 90% and safe in patients with HCV infection and CKD. According to the stage of CKD, HCV infection should be treated.

C-reactive protein (CRP) is a blood marker for inflammation and is an independent prognostic factor for many human cancers. Combined with albumin levels, it forms the basis of the Glasgow Index for cancer prognosis. We reviewed the literature on CRP and HCC and also evaluated blood CRP levels and combination CRP plus albumin levels in a large HCC cohort. In order to understand the prognostic significance of CRP, we retrospectively examined a large HCC cohort and examined the relationship of CRP levels to tumor parameters. We report, that CRP alone and CRP plus albumin combined as well, significantly correlated with parameters of HCC aggressiveness, such as maximum tumor dimension (MTD), portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels, both as individual parameters and all parameters together (Aggressiveness Index). This extends current thinking, to suggest a possible explanation for the usefulness of blood CRP levels in HCC prognostication.

ALTINTAS, Engin/0000-0003-0796-1456; Sonsuz, Prof.Dr.Abdullah/0000-0002-8336-5472; ALTINTAS, ENGIN/0000-0003-0796-1456; kuran, sedef/0000-0001-7019-8911; uskudar, oguz/0000-0003-2789-1467; EKIN, NAZIM/0000-0001-5302-8953; Akkiz, Hikmet/0000-0001-9745-8875; Tokmak, Salih/0000-0002-2727-5632; Carr, Brian/0000-0002-6111-5077 WOS: 000436297600001 PubMed: 30009156 Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD 10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumormultifocality. A logistic regressionmodel that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD >5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development. NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [CA 82723] This work is supported in part by NIH Grant CA 82723 (Brian I. Carr)Y

Background/aims To evaluate the effectiveness of tenofovir in patients with chronic hepatitis B infection in a real life setting. Materials and methods We performed a retrospective analysis of data from 164 patients with chronic hepatitis B who were treated with Tenofovir. Eighty-six patients (52.4%) were naive. Seventy-seven (46.9%) patients were previously treated with anti-viral drugs, including standard interferon (n=4), pegylated (PEG) interferon (n=14), standard interferon together with lamivudine (n=13), lamivudine alone (n=41), adefovir (n=2), lamivudine together with adefovir (n=1), and entecavir (n=2). Six patients (3.7%) had liver cirrhosis before treatment of tenofovir. Results The patients who have hepatitis B viral DNA>104 copy/mL with chronic hepatitis B infection were included in the treatment of Tenofovir. Average follow up time was 30.31±14.33 months. HBV DNA negativity and alanine aminotransferase (ALT) normalization were 86.5% and 71.3%, respectively, at the last visit. Hepatitis B e-Antigen (HBeAg) seroconversion occurred in 11 (19.6%) out of 164 patients. During the follow-up period, 4 (2.4%) patients developed liver cirrhosis and in 5 (3%) patients hepatocellular carcinoma (HCC) occurred out of 164 patients. HBsAg seroconversion occurred in one patient (0.6%). Conclusion Tenofovir can be used safely and successfully in those patients that were naive, experienced with immune modulators and/or antivirals, HBeAg-positive, and HBeAg-negative patients.

Hepatitis C virus (HCV) infection is a significant health problem. The aim of this study is to evaluate the cost-effectiveness of HCV treatment and estimate its economic burden in Turkey. An Excel-based disease progression model was used to estimate the HCV-infected population for 2015–2030. Direct costs in US dollars (USD) including diagnostic, laboratory, and healthcare costs were provided by experts in the country. Indirect costs were estimated as lost productivity using the World Health Organization (WHO) disability-adjusted life years (DALYs) metric from the Global Burden of Disease study. Three scenarios were developed to estimate the cost-effectiveness of HCV treatment through 2030: Base 2016, Increase Treatment and SVR (where SVR is sustained virological response), and WHO Targets. Additionally, the WHO Targets scenario was assessed at three different treatment price points: 10,900 USD, 16,730 USD (base cost), and 27,285 USD. Cumulative total direct and indirect costs (2015–2030) for the WHO Targets scenario were estimated to be 10.8 billion USD, or a 1.5 % increase compared with Base 2016. However, by the following decade, due to a marked decline in DALYs, cumulative direct and indirect costs were estimated to be 45 % less when compared with Base 2016. At a threshold of 9125 USD, all scenarios were cost-effective. By implementing the WHO Targets scenario, Turkey would be able to lower HCV prevalence by 80 % and reduce the total number of liver-related deaths by >65 % by 2030. Treating HCV infection in the country is cost-effective if healthcare and indirect costs are taken into consideration.

Cystic echinococcosis is an infectious disease that is potentially associated with the biliary tract. Of thousand cases of hydatid cysts that were successfully treated by the Ormeci method, only two presented with cholangitis subsequent to the percutaneous treatment. These cases were treated with endoscopic retrograde cholangiopancreatography, and this study provides details regarding the clear fistulization of hydatid cysts into the biliary tract.

Iron deficiency (ID) and iron deficiency anemia (IDA) are important signs of gastrointestinal (GI) hemorrhage. Therefore, the evaluation of the GI tract should be a part of the diagnostic protocol in patients with IDA. GI hemorrhage is not a disease but a symptom, which might have different underlying causes. ID and IDA have significant negative impacts on the life quality and work ability, and they may lead to frequent hospitalization, delay of discharge, and increased healthcare costs. Therefore, an optimal management of the disease causing GI hemorrhage should include iron replacement therapy, along with the treatment of the underlying condition. IDA in inflammatory bowel disease (IBD) has received particular attention owing to its high prevalence, probably due to a number of other factors such as chronic hemorrhage, reduced dietary iron intake, and impaired absorption of iron. Historically, in IBD and in patients with GI hemorrhage, the diagnosis and management of IDA have been suboptimal. Options for iron replacement include oral and intravenous (IV) iron supplementation. Oral iron supplementation frequently results in GI side effects, and theoretically, it may exacerbate IBD activity; therefore, IV iron supplementation is usually considered in patients not responding to or not complying with oral iron supplementation or patients having low hemoglobin concentration and requiring prompt iron repletion. The aim of this report was to review the diagnostic and therapeutic considerations of IDA in IBD and GI hemorrhage with a multidisciplinary group of experts and to formulate necessary practical recommendations., NA

Hydatid disease is caused by the larval stages of Echinococcus Granulosus. Most patients with hydatid disease have no symptoms, unless there is compression of vital organs such as the hepatic veins, portal vein, hepatic artery in the liver, bronchia in the lungs or the brain, resulting in life threatening complications like anaphylactic shock and sudden death. There are four treatment strategies for cystic echinococcosis (CE)- surgery, percutaneous methods, medical treatments and watch and wait strategies. Medical treatment with albendazol, mebendazole or prazyquentel may cure only 2/3 of patients with CE. More than 30% of patients will reoccur after stopping the treatment. Watch and wait strategy is followed for asymptomatic and small cysts or CE type IV and Type V cysts. Surgical treatments were the gold standard for treatment of CE until the last 30 years. Consequently, surgical methods decreased while percutaneous methods of treatment increased. Due to higher mortality, morbidity, recurrence rates, longer hospital stays and higher costs in comparison to percutaneous methods like PAIR and ÖRMECİ technique, surgical treatment must be limited for the complicated hydatid cyst. Both the PAIR and Örmeci techniques are safe and effective. However, the Örmeci technique offers a simpler, inexpensive method of treatment, with no mortality, lower morbidity, low recurrence rate, while being out patient based. It can be used as the first choice of treatment modality in patients with cysts type CE type one, CE type two, CE Type 3A and CE Type 3B. In this review, treatment modalities for CE, but mainly percutaneous treatment, will be discussed.