Changes in Hepatitis C Awareness in Different Disciplines During COVID-19.

BACKGROUND: We aimed to determine the awareness of referring hepatitis C virus patients to the relevant departments and the effect of the pandemic period on this subject. METHODS: A total of 65 743 patients with anti-hepatitis C virus requests before and during the COVID-19 pandemic were retrospectively screened. Anti-hepatitis C virus-positive patients were divided into 5 groups according to age distribution. The distribution of patients with anti-hepatitis C virus positivity was compared according to age groups, before and during COVID-19. Anti-hepatitis C virus-pos- itive patients who were not requested hepatitis C virus RNA were evaluated individually according to the departments, and hepatitis C virus awareness was compared before and during COVID-19. RESULTS: Anti-hepatitis C virus positivity rate was 1.54% before COVID-19; this rate was 2.15% during COVID-19. When the anti-hep- atitis C virus positivity rate was compared in terms of age distribution according to before and during COVID-19, it was observed that there was a statistically significant decrease in the >65 age group in the COVID-19 period (P = .004). It was found that 216 (32%) of the patients who had anti-hepatitis C virus (+) before COVID-19 and 231 (48.1%) of the patients during COVID-19 were not requested hepatitis C virus RNA test (P < .0001). The departments with the highest awareness of hepatitis C virus were gastroenterology, infec- tious diseases, hematology, gynecology and obstetrics, and oncology, while the departments with the lowest hepatitis C virus awareness were ophthalmology, psychiatry, and general surgery. It was found that chronic hepatitis C virus awareness decreased in all departments during COVID-19. CONCLUSION: Hepatitis C virus awareness has decreased in all medical departments despite the physician alert system during COVID-19 and also the rate of anti-hepatitis C virus (+) patients decreased in the group aged >65 years during the pandemic.

Investigation of Dynamic Thiol/Disulfide Homeostasis and Nitrosative Stress in Patients with Wilson Disease.

BACKGROUND: Wilson disease (WD) is an autosomal recessive inherited disorder of copper (Cu2+) metabolism, resulting in Cu2+ accumulation and liver and central nervous system toxicity. Oxidative stress may have a role in the pathogenesis of Wilson disease, but the roles of thiol/disulfide homeostasis and nitrosative stress have not been examined. The purpose of this study was to evaluate whether there is a modification in thiol/disulfide homeostasis and nitrosative stress in patients with Wilson disease. METHODS: A total of 50 patients with Wilson disease (42 under drug treatment and 8 newly diagnosed patients with no drug treatment) and 50 healthy gender- and age-matched controls were enrolled for this study. Serum native thiol and total thiol levels were measured with a spectrophotometric method. The number of disulfide bonds and the related ratios were determined from these measurements. Serum nitric oxide (NO) and 3-nitrotyrosine (3-NT) levels were analyzed using chemiluminescence and ELISA assays, respectively. RESULTS: The average native thiol levels of the patient group under drug treatment were found to be markedly higher than the levels of controls (P < .05). We detected no marked changes in total thiol and disulfide levels, and disulfide/total thiol, disulfide/native thiol, or native thiol/total thiol ratios between groups. We found significant elevations in NO levels in Wilson disease group before drug treatment, and the 3-NT levels in the Wilson disease groups prior to (P < .05) and under drug treatment (P < .01), when compared to controls. CONCLUSION: Our data are the first to show that nitrosative stress and thiol/disulfide homeostasis can contribute to the pathogenesis of Wilson disease.

Comparison of early and delayed diagnosis of mortality in ERCP perforations: A high-volume patient experience.

BACKGROUND: Although ERCP (Endoscopic retrograde cholangiopancreatography) perforation is a rare complication, it results in high morbidity and mortality. In this study, clinical evaluation was performed concerning the incidence, clinical data and time of diagnosis for ERCP perforations that were either surgically or medically treated. To reduce the ERCP perforations and related mortality, in this study, we aimed to reveal the clinical features and compare them with the literature. METHODS: In this clinical retrospective study, 51 perforations were detected in 8676 ERCP procedures performed in the past eight years in our hospital. We compared the two groups: early diagnosed patients [Group 1: n=40] and the delayed diagnosed patients [Group 2: n=11] concerning primary diagnosis, blood and biochemical tests before ERCP, perforation type, treatment method, clinical features, length of stay, and mortality. These groups were compared concerning stent placement, papillotomy choledochal dilatation and the number of ERCP procedures. RESULTS: The ERCP perforation rate in our hospital was 0.59%. The majority of patients who underwent ERCP procedures was due to the choledocholithiasis and periampullary tumors. The mean age was 62.78±17.13 (24-89 years old) and 56.9% of the patients (n=29) were women. Stapfer type II perforations (49%) were the most common type of perforation. However, 62.5% of the total mortality occurred in patients with type I perforation. The overall mortality rate was 13.72% (n=7). The duration of hospitalization (13.38±10.09 days) was higher in the patients who were treated surgically (n=24). Choledochal stents were utilized mostly in the medically treated patients (74.1%) (p=0.039). The patients in Group 1 were detected visually by the operator during the ERCP by leakage of contrast substance (13/40) or by abdominal tomography due to clinical suspicion. Patients in Group 2 had higher pre-ERCP leukocyte levels (p=0.044). The urgent surgery requirement in Group 2 was 72.7%, while the mortality rate was 36.4%. Significant mortality difference was observed between the early and late detection of perforations, indicating a higher rate in Group 2 (p=0.014). CONCLUSION: In the patients who were diagnosed early, fewer surgical interventions were required, except for the type I perforations. Type II perforations can often be safely treated non-surgically if there are no signs of acute abdomen and sepsis. Early diagnosis and treatment significantly reduce ERCP-related mortality.

Does celiac disease cause autoimmune sensorineural hearing loss?

BACKGROUND/AIMS: The primary aim of this study is to identify whether an autoimmune sensorineural hearing loss is an extraintestinal neurological manifestation in adult CD patients. The secondary aim is to identify whether the duration of a gluten-free diet has an effect on the hearing levels of CD patients. MATERIALS AND METHODS: This prospective study consisting of 103 adult CD patients and 79 healthy controls between May 2012 and August 2018 at the University of Gaziantep Gastroenterology and Otorhinolaryngology Departments. CD patients were divided into two groups as remission or active, according to their gluten-free diet duration and serum levels of anti-t-TG. The control group was checked both for CD symptoms and anti-t-TG serum levels. Both participants performed a pure tone audiometry after detailed ear nose and throat examination. RESULTS: Only 4 of 103 CD patients showed sensorineural hearing loss. There was no statistically significant difference between hearing levels of the CD patients and the control group in both measurements of air and bone conductions. The hearing levels comparing the remission and active CD patients did not show any difference in air and bone conduction frequencies. CONCLUSION: In this study with a higher number of CD patients when compared with the previous studies, it has been shown that CD does not appear to cause autoimmune sensorineural hearing loss. In addition, the status of the patients regarding the activeness or the remission of CD did not display a differ between the CD patients in terms of hearing levels.

Efficacy and safety of endoscopic retrograde cholangiopancreatography in pregnancy: A high-volume study with long-term follow-up.

BACKGROUND/AIMS: Pancreaticobiliary diseases are observed more frequently in pregnancy due to increased biliary stone formation. There are some concerns about the use of endoscopic retrograde cholangiopancreatography (ERCP) because of potential fetal exposure to radiation and serious adverse events, such as post-ERCP pancreatitis, which increases fetal or maternal morbidity and mortality. The aim of this study was to evaluate the efficacy and safety of ERCP during pregnancy and to present our experience. MATERIALS AND METHODS: This study included 25 pregnant patients who underwent ERCP due to biliopancreatic pathologies between 2010 and 2017. Indications for ERCP were choledocholithiasis (n=12), biliary pancreatitis (n=9), and acute cholangitis (n=4). ERCP procedures were performed using fluoroscopy (n=18) and the non-radiation technique (n=7). The duration of fluoroscopy was recorded in all cases. Fetal and maternal complications were both assessed. RESULTS: The mean age of patients was 29.4 (range, 21-40) years, and the mean duration of pregnancy was 19.9 weeks. All the 25 ERCP procedures were performed successfully. Biliary sphincterotomy was performed in all patients, and 18 patients with choledocholithiasis underwent stone extraction. The average procedure duration was 11 min, and the average duration of fluoroscopy was 6 s. There were no major complications in any patient. After the deliveries, the newborns were apparently healthy during the follow-up period of 1-7 years. CONCLUSION: Either conventional or non-radiation ERCP procedures can be performed successfully in pregnancy, with no increase in the number of feto-maternal complications when performed by experienced endoscopists.

Role of nucleoside/nucleotide analogues and low-dose hepatitis B immune globülin in prophylaxis of hepatitis B recurrence among cadaveric liver transplant recipients.

BACKGROUND/AIMS: Hepatitis B core antibody (HBcAb) positivity of the donor or the recipient may pose a risk of hepatitis B virus (HBV) reactivation following liver transplantation (LT). We retrospectively investigated patient survival and reactivation among recipients who were given low-dose Hepatitis B Immune Globulin (HBIG) plus antiviral agent (AV) versus AV only. MATERIALS AND METHODS: Records of cadaveric LT recipients, between 2013 and 2016, with positive Hepatitis B surface Antigen (HBsAg) and/or HBcAb and recipients who had received LT from HBcAb-positive donors were reviewed. Patient characteristics and clinical data were extracted. Donor variables were retrieved from the United Network of Organ Sharing (UNOS) database. HBIG (1560 IU/mL) Intravenous (IV) was intraoperatively administered with three daily doses. Entecavir 1 mg daily was also given. STATA was used for statistical analysis. RESULTS: There were 53 recipients; 39 (73.6%) were male with a median age of 59 y. HCV was the major indication in 30 (55.6%) patients. There were 28 recipients (52.8%) who received HBIG plus AV and 25 (47.2%) received AV only. The Model of End Stage Liver Disease (MELD) score between the groups were similar. Survival rates at 6, 12, and 24 months were 100% (n=53), 93.2% (n=44), and 100.0% (n=26), respectively. There was no reactivation; two recipients in the AV group and one in the HBIG plus AV group died within 12 months. CONCLUSION: This study supports the use of low-dose HBIG and AV for post-LT prophylaxis to be as effective as conventionally used high-dose HBIG (9600 IU) plus AV. Future prospective larger studies are warranted to examine the potential benefits of using AV alone without HBIG.

Comparison of the effects of esomeprazole 40 mg, rabeprazole 20 mg, lansoprazole 30 mg, and pantoprazole 40 mg on intragastric pH in extensive metabolizer patients with gastroesophageal reflux disease.

BACKGROUND/AIMS: Studies on the therapeutic efficacy of proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD) have been recently published. In most of these studies, comparison of only two PPIs have been made. There are few studies on the comparison of four or more PPIs. We aimed to compare the acid inhibitory effects of esomeprazole 40 mg, rabeprazole 20 mg, lansoprazole 30 mg, and pantoprazole 40 mg on days 1 and 5 of treatment in patients with GERD, who were extensive metabolizers in regard to the CYP2C19 genotype. MATERIALS AND METHODS: Helicobacter pylori-negative with typical symptoms of GERD patients were randomly divided into four treatment groups. Efficacy analysis on days 1 and 5 were performed on the four groups which comprised 10 (esomeprazole), 11 (rabeprazole), 10 (lansoprazole), and 10 (pantoprazole) patients. RESULTS: On day 1 of PPI treatment, the mean percentage of time with intragastric Ph>4 were 54%, 58%, 60%, and 35% for the groups, respectively, and on day 5, these values were 67%, 60%, 68%, and 59%, respectively. Esomeprazole, rabeprazole, and lansoprazole were found to be superior to pantoprazole on the first day of treatment. CONCLUSION: Pantoprazole is a less potent proton pump inhibitor than the other PPIs tested on the first day of treatment. When the time needed to raise the intragatric pH to over 4 was evaluated, esomeprazole was found to have the most rapid action, followed by lansoprazole and rabeprazole.

The prevalence of CYP2C19 mutations in Turkish patients with dyspepsia.

BACKGROUND/AIMS: We aimed to determine the distribution of cytochrome P450 2C19 (CYP2C19) genotype frequencies in Turkish patients with dyspepsia. METHODS: CYP2C19 genotype was determined in 100 Turkish patients with dyspepsia. DNA of the patients was isolated from whole blood and genotypes were detected by specific probes in real-time polymerase chain reaction (PCR). RESULTS: The frequencies of heterozygous CYP2C19*2 and CYP2C19*3 genotypes were 13% and 1% in dyspeptic patients, respectively. Homozygous mutant CYP2C19*2 was detected at a rate of only 1% in the study population, and homozygous mutant genotype of CYP2C19*3 was not found. The frequencies of homozygous CYP2C19*2 and CYP2C19*3 genotypes were 86% and 99% in dyspeptic Turkish patients, respectively. CONCLUSIONS: This is the first study investigating CYP2C19 polymorphism in dyspeptic Turkish patients. Our investigation revealed that the most common CYP2C19 genotype was wild type CYP2C19 in dyspeptic Turkish patients. Dyspeptic Turkish patients are extensive metabolizers for proton pump inhibitors. This finding might have impact on the clinical consequences for the treatment strategies in dyspepsia.