The right ventricle outflow tract systolic function could predict the severity of the cirrhosis.

Background/aim: The distinctive liver framework is converted into structurally abnormal nodules as a consequence of tissue fibrosis in cirrhosis. Cardiac dysfunction in cirrhosis was described, and the term "cirrhotic cardiomyopathy (CCM)" was coined to describe this syndrome. Recent research has shown that the contractile characteristics of the right ventricular outflow tract (RVOT) have a significant impact on right ventricular functions. The right ventricular outflow tract-systolic excursion is an important systolic function marker of RVOT (RVOT-SE). There has yet to be published research on RVOT function in cirrhotic patients. We looked at the relationship between cirrhosis severity and the RVOT-SE. Materials and methods: Sixty-nine consecutive hepatic cirrhotic patients were recruited for the research between June 1, 2018 and January 1, 2022. A medical history, thorough physical examination, laboratory investigations, echocardiographic evaluation, and RVOT-SE were obtained. The patients were separated into two groups: those with compensated cirrhosis (Child-Pugh class 1) and those with decompensated cirrhosis (Child-Pugh class 2 and 3). Results: On the numerous standard echocardiographic parameters that examined the diameter and function of the left ventricle, we observed no significant difference between groups. Nevertheless, a statistically significant difference in Right Ventricle Wall (RVW) (p = 0.014), systolic pulmonary artery pressure (sPAP) (p = 0.034), RVOT-SE (p = 0.003), and Tricuspid Annular Plane Systolic Excursion (TAPSE) (p = 0.042) was detected across cirrhosis groups. The RVOT-SE had a positive correlation with cirrhosis severity (OR: 0.607; 95% CI: 0.425-0.866; p = 0.006), according to multiple logistic regression studies. According to the ROC curve study, RVOT-SE 8.8 cm/s predicted decompensated cirrhosis with 72% sensitivity and 72.7% specificity (AUC = 0.715, p: 0.001). Conclusion: In the current study, we found that RVOT-SE was related to the severity of cirrhosis. Larger patient cohorts and multi-center investigations will provide light on the notion.

In a Real-Life Setting, Direct-Acting Antivirals to People Who Inject Drugs with Chronic Hepatitis C in Turkey.

BACKGROUND: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. METHODS: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. RESULTS: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). CONCLUSION: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization's objective of eliminating viral hepatitis.

Characteristics of patients with hepatocellular carcinoma: A multicenter study.

Background and Aim: The aim of the present study was to examine the etiology of hepatocellular carcinoma (HCC) by underlying cause and determine the characteristics and clinical features of patients with HCC. Materials and Methods: The study comprised 1802 HCC patients diagnosed and followed up by Liver Diseases Outpatient Clinics in 14 tertiary centers in Turkey between 2001 and 2020. Results: The mean age was 62.3±10.7 years, and 78% of them were males. Of the patients, 82% had cirrhosis. Hepatitis B virus (HBV) infection was the most common etiology (54%), followed by hepatitis C virus (HCV) infection (19%) and nonalcoholic fatty liver disease (NAFLD) (10%). Of the patients, 56% had a single lesion. Macrovascular invasion and extrahepatic spread were present in 15% and 12% of the patients, respectively. The median serum alpha-fetoprotein level was 25.4 ng/mL. In total, 39% of the patients fulfilled the Milan Criteria. When we compared the characteristics of patients diagnosed before and after January 2016, the proportion of NAFLD-related HCC cases increased after 2016, from 6.6% to 13.4%. Conclusion: Chronic HBV and HCV infections remain the main causes of HCC in Turkey. The importance of NAFLD as a cause of HCC is increasing.

Beliefs About Medicines and Adherence to Treatment in Turkish Patients with Inflammatory Bowel Disease.

BACKGROUND: Although studies are investigating the perception and beliefs about treatment and adherence to treatment in different societies related to inflammatory bowel disease, there are no studies on this subject in Turkish people with different sociocultural structures. In our study, we aimed to evaluate the beliefs about treatment and its effect on adherence to treatment in the Turkish population with inflammatory bowel disease. METHODS: In the study, the "Medication Adherence Report Scale" and "Beliefs about Medicines Scale" scales were used to evaluate the treatment compliance and perception and beliefs about treatment. Characteristics that could affect treatment compliance were evaluated by statistical analysis. RESULTS: A total of 253 patients, 167 with ulcerative colitis and 86 with Crohn's disease, were included in the study. The non-adherence rate to the treatment was found as 41.9% in ulcerative colitis and 24.4% in Crohn's disease (P = .006). Intentional (29.3% in ulcerative colitis and 16.3% in Crohn's disease [P = .031] and unintentional non-adherence to treatment (28.1% in ulcerative colitis, 16.3% in Crohn's disease [P = .037] were significantly higher in ulcerative colitis than in Crohn's disease. Female gender (odds ratio = 2.59, P = .005), low education level (odds ratio = 4.8, P = .015), distal involvement in ulcerative colitis (P = .014), and thoughts about the disease would last too soon in Crohn's disease (odds ratio = 4.17, P = .049) were risk factors for non-adherence to treatment. CONCLUSION: The negative perception of treatment in inflammatory bowel disease affects adherence to the treatment. Considering some social factors that affect adherence to the treatment and taking measures to enhance the adherence to treatment will increase the success of treatment.

Efficacy and Safety of Direct-Acting Antivirals in Elderly Patients with Chronic Hepatitis C: A Nationwide Real-Life, Observational, Multicenter Study from Turkey.

BACKGROUND: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. METHODS: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (≥65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. RESULTS: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P = .879, P = .508 for modified evaluable population and P = .058, P = .788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir+ribavirin had a significantly lower sustained virological response 12 rates (P < .001, P = .047, P = .013, and P = .025, respectively). CONCLUSION: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.

Gamma-glutamyl-transferase may predict COVID-19 outcomes in hospitalised patients.

AIM: In this study, we aimed to define the predictive role of liver function tests at admission to the hospital in outcomes of hospitalised patients with COVID-19. MATERIAL AND METHOD: In this multicentric retrospective study, a total of 269 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalised for the treatment were enrolled. Demographic features, complete medical history and laboratory findings of the study participants at admission were obtained from the medical records. Patients were grouped regarding their intensive care unit (ICU) requirements during their hospitalisation periods. RESULTS: Among all 269 participants, 106 were hospitalised in the ICU and 66 died. The patients hospitalised in ICU were older than patients hospitalised in wards (P = .001) and expired patients were older than alive patients (P = .001). Age, elevated serum D-dimer, creatinine and gamma-glutamyl transferase (GGT) levels at admission were independent factors predicting ICU hospitalisation and mortality in COVID-19 patients. CONCLUSION: In conclusion, in hospitalised patients with COVID-19, laboratory data on admission, including serum, creatinine, GGT and d-dimer levels have an important predictive role for the ICU requirement and mortality. Since these tests are readily available in all hospitals and inexpensive, some predictive formulas may be calculated with these parameters at admission, to define the patients requiring intensive care.

Is there any link between atrial arrhythmias and inflammatory bowel disease?

BACKGROUND: Inflammation plays an important role in the development of cardiovascular disease, including atherosclerosis and arrhythmia. The aim of this study was to evaluate atrial conduction times (ACTs) in patients with inflammatory bowel disease (IBD) in which systemic chronic inflammation is evident. METHODS: In this cross-sectional, prospective, single-center study, 79 IBD patients (51 ulcerative colitis; 28 Crohn's disease) and 70 healthy controls were included. Atrial electromechanical properties were measured by recording simultaneous surface electrocardiography (ECG) with transthoracic echocardiography (ECHO) and tissue Doppler imaging methods. The relationship between age, disease duration, and ACT was evaluated. RESULTS: There were significantly increased conduction durations of lateral-PA (time interval from the onset of the P-wave on surface ECG to the beginning of the late diastolic wave), septal-PA, tricuspid-PA, and interatrial-electromechanical delay (IA-EMD), right intraatrial EMD, and left intraatrial (LI-EMD) durations in IBD patients (P < 0.001). In IBD patients, there was a positive correlation with age, lateral PA, septal PA, tricuspid PA, IA-EMD, and LI-EMD (P < 0.05). A positive correlation was found between disease duration and only lateral PA and tricuspid PA (P < 0.05). CONCLUSION: In IBD patients, prolonged ACT consists a potential risk for severe atrial arrhythmias. ECG and ECHO screening can be useful in identifying risk groups in IBD patients and taking precautions for future cardiac complications.

Comparison of the Efficacy of Entecavir and Tenofovir in Reducing Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients: A Real-Life Study in Turkey.

BACKGROUND: It is controversial whether entecavir or tenofovir differs in reducing hepatocellular carcinoma (HCC) risk. We aimed to compare the efficacy of entecavir and tenofovir in reducing HCC risk in chronic hepatitis B (CHB) patients. METHODS: This retrospective study included 607 nucleos(t)ide naive CHB patients who had received entecavir or tenofovir. Patients who developed HCC during the first 12 months of therapy were excluded. Cumulative HCC incidences at years 2, 3, 4, 5 and 10 were compared between entecavir and tenofovir groups. Factors associated with HCC were determined by univariate and multivariate analyses. RESULTS: Nineteen (3.1%) patients developed HCC, 12 (4.8%) in entecavir group and 7 (1.9%) in tenofovir group (P = .045). In the entire cohort, cumulative HCC incidences at years 2, 3, 4, 5 and 10 were 1.8%, 2.9%, 4.4%, 5.2% and 9.9% in entecavir group, and 0.6%, 2.4%, 2.4%, 2.4% and 3.7% in tenofovir group, respectively (log-rank P = .130). In multivariate analysis, age ≥50 years, cirrhosis, decompensated cirrhosis, high GGT and low platelet levels were associated with HCC in the entire cohort. In advanced fibrosis/cirrhosis cohort, cumulative HCC incidences at years 2, 3, 4, 5 and 10 were 4.6%, 7.1%, 8.6%, 12.1% and 15.5% in entecavir group, and 1.8%, 5.6%, 5.6%, 5.6% and 8.5% in tenofovir group, respectively (log-rank P = .267). In multivariate analysis, age ≥50 years, decompensated cirrhosis, high GGT and low platelet levels were associated with HCC in the advanced fibrosis/cirrhosis cohort. CONCLUSION: Entecavir and tenofovir are similarly effective in reducing HCC risk in CHB patients.

Long-term proton pump inhibitor use is a risk factor for mortality in patients hospitalized for COVID-19

Background and aim: The aim of this study is to evaluate whether the long-term (≥4 weeks) use of proton pump inhibitors (PPIs) is a risk factor for intubation requirement and mortality in patients hospitalized for COVID-19. Materials and methods: In this multicentric retrospective study, a total of 382 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalized for treatment were enrolled. The patients were divided into two groups according to the periods during which they used PPIs: the first group included patients who were not on PPI treatment, and the second group included those who have used PPIs for more than 4 weeks. Results: The study participants were grouped according to their PPI usage history over the last 6 months. In total, 291 patients did not use any type of PPI over the last 6 months, and 91 patients used PPIs for more than 4 weeks. Older age (HR: 1.047, 95% CI: 1.026­1.068), current smoking (HR: 2.590, 95% CI: 1.334­5.025), and PPI therapy for more than 4 weeks (HR: 1.83, 95% CI: 1.06­2.41) were found to be independent risk factors for mortality. Conclusion: The results obtained in this study show that using PPIs for more than 4 weeks is associated with negative outcomes for patients with COVID-19. Patients receiving PPI therapy should be evaluated more carefully if they are hospitalized for COVID-19 treatment.

Social stigmatization in Turkish patients with chronic hepatitis B and C / Estigmatización social en pacientes turcos con hepatitis crónica B y C

Background and aim: Viral hepatitis is the most important cause of chronic hepatitis worldwide. Stigmatization is defined as a feeling of rejection and isolation of patients by society due to illness. There are no studies on chronic viral hepatitis in the literature in English, which has its own religious and socio-cultural structure. In our study, we aimed to investigate the presence of social stigmatism and psychosocial effects on patients with different stages of chronic viral hepatitis B and C. Methods: Forty-five patients with chronic hepatitis C and 114 patients with chronic hepatitis B were enrolled in the study. Berger's scale was used for stigmatization, composed of 40 four-point Likert items that have four subscales: personalized stigma, disclosure, negative self-image, and public attitude. Stigma score ranges between one and four. Stigma is accepted as present if the overall score is above two. Results: Overall the mean stigma scores were 1.97±0.58 and 2.14±0.57 for chronic hepatitis B and C, respectively. There was stigma in 47.4% of the patients with chronic hepatitis B, and 60% of the patients with chronic hepatitis C. Being male was the risk factor on overall stigma, disclosure and public attitude in chronic hepatitis C. Living in an urban setting was the risk factor on negative self-image in chronic hepatitis C and on personalized stigma and disclosure in chronic hepatitis B. Conclusions: To the best of our knowledge, this is the first study that provides qualitative information about chronic hepatitis-related stigma. Stigmatization is a major problem in Turkey and worldwide. We believe that increasing the knowledge of the patients and society by teaching about the transmission routes of the disease and focusing on vaccination studies will prevent stigmatization.(AU)

Antecedentes y objetivo: La hepatitis viral es la causa más importante de hepatitis crónica en todo el mundo. La estigmatización se define como un sentimiento de rechazo y aislamiento de los pacientes, por parte de la sociedad debido a su enfermedad. No hay estudios sobre la hepatitis viral crónica en la literatura inglesa, que tiene su propia estructura religiosa y sociocultural. En nuestro estudio, nos propusimos investigar la presencia del estigma social y los efectos psicosociales en los pacientes con diferentes fases de hepatitis viral crónica B y C. Métodos: Se incluyó en el estudio a 45 pacientes con hepatitis crónica C y 114 pacientes con hepatitis crónica B. Se utilizó la escala de Berger para la estigmatización, compuesta por 40 ítems Likert de cuatro puntos, con cuatro subescalas cada uno: estigma personalizado, revelación, imagen negativa de sí mismo y actitud pública. La puntuación del estigma oscila entre uno y cuatro. El estigma se acepta como presente si la puntuación general es superior a dos. Resultados: En general, la media de las puntuaciones de estigmatización fue de 1,97 ± 0,58 y 2,14 ± 0,57 para la hepatitis crónica B y C, respectivamente. El 47,4% de los pacientes con hepatitis crónica B y el 60% de los pacientes con hepatitis crónica C sufrieron estigmatización. El hecho de ser varón fue el factor de riesgo del estigma general, la revelación y la actitud pública en la hepatitis crónica C. Vivir en un entorno urbano fue el factor de riesgo de la imagen negativa de sí mismo en la hepatitis crónica C y el estigma personalizado y la revelación en la hepatitis crónica B. Conclusiones: Hasta donde sabemos, este es el primer estudio que proporciona información cualitativa sobre el estigma relacionado con la hepatitis crónica. La estigmatización es un problema importante en Turquía y en todo el mundo...(AU)

Preliminary examination of the relations between disease stage, illness perceptions, coping strategies, and psychological morbidity in chronic hepatitis B and C guided by the Common-Sense Model of Illness.

BACKGROUND AND AIMS: Chronic viral hepatitis (CVH) has a spectrum from asymptomatic disease to cirrhosis and hepatocellular carcinoma. In our study, we aimed to establish the relations between disease stage, illness perception, coping strategies and psychological morbidity in CVH. METHODS: A total of 182 patients with chronic hepatitis B (CHB) (n = 136) and chronic hepatitis C (CHC) (n = 46) were enrolled. Illness perceptions were measured with the Brief Illness Perceptions Questionnaire. Coping strategies were measured with the Carver Brief Coping Questionnaire. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Relations were evaluated by structural equation modeling (SEM). RESULTS: In CHB, combining the questionnaire data using SEM resulted in a final model with an excellent fit [χ2 (2) = 0.00, P = 1.000, χ2/N = 0.00, root mean square error of approximation (RMSEA) < 0.001, comparative fit index (CFI) = 1.000, goodness-of-fit index (GFI) = 1.000]. Disease stage had a significant direct influence on illness perceptions (ß = 0.23, P = 0.006). Illness perceptions had a significant direct influence on emotional coping strategy, depression and anxiety (ß = 0.20, P = 0.019; ß = 0.33, P < 0.001; ß = 0.59, P < 0.001, respectively). While the use of emotional coping strategies was associated significantly (P = 0.01) with the presence of anxiety, problem-focused coping strategy was associated with depression (P = 0.004). In CHC, SEM resulted in a final model with an excellent fit [χ2 (2) = 0.078, P = 0.962, χ2/N = 0.039, RMSEA<0.001, CFI = 1.000, GFI = 0.999]. Disease stage did not have a significant direct influence on illness perceptions (P > 0.05). Illness perceptions had a significant direct influence on depression and anxiety (ß = 0.27, P = 0.023; ß = 0.44, P < 0.001, respectively). CONCLUSION: The psychological consequences of the disease vary depending on the person's perception of illness and coping strategies.

Validation of the HCC-RESCUE score to predict hepatocellular carcinoma risk in Caucasian chronic hepatitis B patients under entecavir or tenofovir therapy.

The HCC-RESCUE score was developed to predict hepatocellular carcinoma (HCC) risk in Korean chronic hepatitis B (CHB) patients under entecavir therapy. We aimed to validate the HCC-RESCUE score to predict HCC risk in Caucasian CHB patients under entecavir or tenofovir therapy and to compare the predictive performance of the HCC-RESCUE score with those of the CAMD, PAGE-B and modified PAGE-B (mPAGE-B) scores. The study included 647 nucleos(t)ide analogue-naive noncirrhotic and compensated/decompensated cirrhotic patients who had received entecavir or tenofovir for ≥6 months and did not develop HCC during the first 6 months of therapy. Patients with HCC-RESCUE scores ≤64, 65-84 and ≥85 points were classified into low-, intermediate- and high-risk groups, respectively. The AUROCs of the HCC-RESCUE, CAMD, PAGE-B and mPAGE-B scores to predict HCC risk at 5 years were 0.875, 0.870, 0.866 and 0.880, and those at 10 years were 0.862, 0.845, 0.841 and 0.862, respectively (both p > .05). Cumulative HCC incidences at 5 years were 0.0%, 10.5% and 15.8%, and those at 10 years were 1.4%, 15.5% and 24.9%, respectively, in the low-, intermediate- and high-risk groups based on the HCC-RESCUE score (both log rank p < .001). In the entecavir versus tenofovir cohorts, the AUROCs of the HCC-RESCUE score to predict HCC risk at 5 and 10 years were 0.831 versus 0.898 and 0.803 versus 0.910, respectively (both p > .05). The HCC-RESCUE score accurately predicted HCC risk in Caucasian CHB patients under entecavir or tenofovir therapy. A substantial proportion of patients can be dropped from HCC surveillance by using the HCC-RESCUE score.

Evaluation of epicardial adipose tissue and carotid intima-media thickness as a marker of atherosclerosis in patients with inflammatory bowel disease.

BACKGROUND AND AIM: this study aimed to compare carotid intima media (CIMT) and epicardial adipose tissue (EAT) measurements, which are considered as markers for the detection of early atherosclerosis in healthy controls and inflammatory bowel disease (IBD) cases. METHODS: a total of 60 IBD patients (25 Crohn's disease and 35 ulcerative colitis) and 60 healthy patients (as a control group) were included in the study. The measurements of CIMT and EAT were performed using echocardiography and ultrasonography, respectively. Statistical analysis was used to determine the relationship between the parameters. RESULTS: the thickness of bilateral (right and left) CIMT and EAT were significantly higher in IBD than in the control group (p < 0.05). There was a positive correlation between EAT and bilateral (right and left) CIMT in IBD patients (p < 0.05). CONCLUSION: IBD is associated with an increased thickness of EAT and CIMT. Chronic inflammation in IBD may increase the risk of atherosclerotic heart disease. Thus, only measuring the thickness of EAT and CIMT can be used as an objective, easy, simple, affordable, non-invasive and accessible assessment method in order to screen for this risk.

Social stigmatization in Turkish patients with chronic hepatitis B and C.

BACKGROUND AND AIM: Viral hepatitis is the most important cause of chronic hepatitis worldwide. Stigmatization is defined as a feeling of rejection and isolation of patients by society due to illness. There are no studies on chronic viral hepatitis in the literature in English, which has its own religious and socio-cultural structure. In our study, we aimed to investigate the presence of social stigmatism and psychosocial effects on patients with different stages of chronic viral hepatitis B and C. METHODS: Forty-five patients with chronic hepatitis C and 114 patients with chronic hepatitis B were enrolled in the study. Berger's scale was used for stigmatization, composed of 40 four-point Likert items that have four subscales: personalized stigma, disclosure, negative self-image, and public attitude. Stigma score ranges between one and four. Stigma is accepted as present if the overall score is above two. RESULTS: Overall the mean stigma scores were 1.97±0.58 and 2.14±0.57 for chronic hepatitis B and C, respectively. There was stigma in 47.4% of the patients with chronic hepatitis B, and 60% of the patients with chronic hepatitis C. Being male was the risk factor on overall stigma, disclosure and public attitude in chronic hepatitis C. Living in an urban setting was the risk factor on negative self-image in chronic hepatitis C and on personalized stigma and disclosure in chronic hepatitis B. CONCLUSIONS: To the best of our knowledge, this is the first study that provides qualitative information about chronic hepatitis-related stigma. Stigmatization is a major problem in Turkey and worldwide. We believe that increasing the knowledge of the patients and society by teaching about the transmission routes of the disease and focusing on vaccination studies will prevent stigmatization.

Combination of Novel c.3484G> T/p.Glu162Ter Variant in ABCB11 and c.208G> A/p.Asp70Asn Variant in ATP8B1 Are Associated with Severe Symptoms in Progressive Family Intrahepatic Cholestasis.

Progressive family intrahepatic cholestasis (PFIC) is an autosomal recessive disease that causes chronic cholestasis. It is associated with pathogenic variants in genes that encode proteins involved in bile secretion to canaliculus from hepatocytes. In this study, we present a 16-year-old boy who presented with severe pruritus and cholestatic jaundice. All possible infectious etiologies were negative. A liver biopsy was consistent with intrahepatic cholestasis and portal fibrosis. DNA was isolated from a peripheral blood sample, and whole exome sequencing was performed. A novel c.3484G > T/p.Glu162Ter variant in the ABCB11 gene and a c.208G> A/p.Asp70Asn variant in the ATP8B1 gene were detected. Despite traditional treatment, the patient's recurrent severe symptoms did not improve. The patient was referred for a liver transplantation. This novel c.3484G > T/p.Glu162Ter variant is associated with a severe and recurrent presentation, and the two compound variants could explain the severity of PFIC.

Epidemiologic features of inflammatory bowel disease in Western Blacksea region of Turkey for the last 10 years: retrospective cohort study.

BACKGROUND/AIMS: There are only a few epidemiological study about inflammatory bowel disease in the last 10 years in Turkey, especially in Western Blacksea region. In our study, we aimed to identify the changes in the incidence and the prevalence of inflammatory bowel disease in Western Blacksea region at the last 10 years. METHODS: Totally 223 patients with inf lammatory bowel disease (160 ulcerative colitis, 63 Crohn's disease) were enrolled in the study followed up between 2004 to 2013 years. The epidemiological characteristics of patients were recorded. RESULTS: The prevalences were 12.53/105 and 31.83/105 for Crohn's disease and ulcerative colitis respectively. Mean annual incidences increased from 0.99/105 and 0.45/105 for ulcerative colitis and Crohn's disease (2004 to 2005 years) to 4.87/105 and 2.09/105 for ulcerative colitis and Crohn's disease respectively (2011 to 2013 years). While the prevalence was higher in urban areas in Crohn's disease (12.60/105 ), it was higher in rural areas in ulcerative colitis (36.17/105 ). In ulcerative colitis, mean annual incidences were 2.91/105 and 2.86/105 for urban and rural areas respectively. In Crohn's disease, they were 1.37/105 and 1.08/105 for urban and rural areas respectively. CONCLUSION: The incidence of inflammatory bowel disease seems to increase in Western Blacksea region at the last 10 years. This increment is more prevalent in rural areas.

Investigation of IL23R, JAK2, and STAT3 gene polymorphisms and gene-gene interactions in Crohn's disease and ulcerative colitis in a Turkish population.

BACKGROUND/AIMS: Inflammatory bowel diseases are chronic, relapsing, inflammatory conditions. They have a genetic backround resulting in patient susceptibility. The aim of our study is to investigate the involvement of IL23R, JAK2, and STAT3 polymorphisms in inflammatory bowel diseases in a Turkish population. MATERIALS AND METHODS: Polymorphisms in IL23R (rs11209026), JAK2 (rs10758669), and STAT3 (rs3816769, rs2293152, rs744166, rs957970, rs8074524) were genotyped in 69 Crohn's disease patients, 157 ulcerative colitis patients, and 89 healthy controls. RESULTS: The presence of (C) in rs10758669, (T) and (TT) in rs957970, and (TT) in rs744166 were found to increase the susceptibility to Crohn's disease (p=0.049, p=0.016, p=0.010, p=0.035, respectively), while rs2293152 (GC), rs744166 (CT), and rs957970 (CT) provide protection against Crohn's disease (p=0.007, p=0.043, p=0.043, respectively). While rs2293152 (GC) was protective, rs2293152 (CC) increased the susceptibility to ulcerative colitis (p=0.009, p=0.001). All the polymorphisms were associated with age-at-diagnosis, except rs11209026. Furthermore, rs2293152 was associated with an extension in ulcerative colitis, while rs10758669, rs3816769, rs744166, rs2293152, and rs957970 were associated with the subphenotype in Crohn's disease. The presence of rs10758669 (AC) was protective against perianal Crohn's disease (p=0.016). Additionally, rs10758669 and rs2293152 in Crohn's disease and rs8074524, rs3816769, and rs10758669 in ulcerative colitis were associated with the requirement of immunsuppression. Finally, rs8074524 and rs10758669 in Crohn's disease and rs11209026 in ulcerative colitis were associated with disease-related operation. CONCLUSION: This is the first study of the single marker association of IL23R, JAK2, and STAT3 polymorphisms with ulcerative colitis and Crohn's disease in a Turkish population. It was demonstrated that these polymorphisms may be effective in the etiology of inflammatory bowel disease in this Turkish population.

Age-based computer-aided diagnosis approach for pancreatic cancer on endoscopic ultrasound images.

AIM: The aim was to develop a high-performance computer-aided diagnosis (CAD) system with image processing and pattern recognition in diagnosing pancreatic cancer by using endosonography images. MATERIALS AND METHODS: On the images, regions of interest (ROI) of three groups of patients (<40, 40-60 and >60) were extracted by experts; features were obtained from images using three different techniques and were trained separately for each age group with an Artificial Neural Network (ANN) to diagnose cancer. The study was conducted on endosonography images of 202 patients with pancreatic cancer and 130 noncancer patients. RESULTS: 122 features were identified from the 332 endosonography images obtained in the study, and the 20 most appropriate features were selected by using the relief method. Images classified under three age groups (in years; <40, 40-60 and >60) were tested via 200 random tests and the following ratios were obtained in the classification: accuracy: 92%, 88.5%, and 91.7%, respectively; sensitivity: 87.5%, 85.7%, and 93.3%, respectively; and specificity: 94.1%, 91.7%, and 88.9%, respectively. When all the age groups were assessed together, the following values were obtained: accuracy: 87.5%, sensitivity: 83.3%, and specificity: 93.3%. CONCLUSIONS: It was observed that the CAD system developed in the study performed better in diagnosing pancreatic cancer images based on classification by patient age compared to diagnosis without classification. Therefore, it is imperative to take patient age into consideration to ensure higher performance.

The efficacy of tyrosine kinase inhibitor dasatinib on colonic mucosal damage in murine model of colitis.

BACKGROUND AND OBJECTIVE: Ulcerative colitis is an inflammatory condition of the colon in the gastrointestinal system. Currently, the most potent medications used for ulcerative colitis produce no response in 20-30% of cases. There is a need for more efficient and reliable medications. Tyrosine kinase inhibitors have shown efficacy in some inflammatory diseases. Although dasatinib, a tyrosine kinase inhibitor, suppresses proinflammatory cytokines in colonic tissue, there are a few cases of hemorrhagic colitis with dasatinib. There is no study investigating the effect of dasatinib on experimental colitis. We aimed to investigate the effect of dasatinib in a colitis model induced with acetic acid in our study. METHODS: In the study, 24 male Sprague-Dawley rats randomly distributed into 4 groups of 6 rats each as control, dasatinib, colitis and dasatinib+colitis groups. For colitis induction, 4% acetic acid was used. Sacrificing of the rats was performed on the seventh day. Disease activity, morphologic and histological injury, superoxide dismutase, myeloperoxidase and malondialdehyde activity, TNFα and CD3 expression were assessed in colonic tissue. RESULTS: Apart from malondialdehyde, significant difference in all parameters between the control and colitis groups was determined. Difference between the colitis and colitis+dasatinib groups was not significant in only weight loss and biochemical parameters. Though dasatinib does not fully resolve the changes in colitis, there was significant regression. CONCLUSIONS: Dasatinib decreased the inflammation in a rodent model of colitis. It may be provide this effect by the suppression of TNFα. Dasatinib may be one of the treatment options for ulcerative colitis.