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Kuru Öz D, Ellik Z, Gürsoy Çoruh A, Adıgüzel M, Gümüşsoy M, Kiremitci S, Kırımker OE, Gökcan H, Elhan AH, Balcı D, Savaş B, Erden A, İdilman R. Assessing hepatic steatosis by magnetic resonance in potential living liver donors. Diagn Interv Radiol 2024; 0:0-0. [PMID: 38737404 DOI: 10.4274/dir.2024.242697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
PURPOSE To determine the accuracy of magnetic resonance imaging-proton density fat fraction (MRI-PDFF) measurements for detecting liver fat content in potential living liver donors and to compare these results using liver biopsy findings. METHODS A total of 139 living liver donors (men/women: 83/56) who underwent MRI between January 2017 and September 2021 were included in this analysis retrospectively. The PDFFs were measured using both MR spectroscopy (MRS) and chemical shift-based MRI (CS-MRI) for each donor in a blinded manner. RESULTS Significant positive correlations were found between liver biopsy and MRS-PDFF and CS-MRI PDFF in terms of hepatic steatosis detection [r = 0.701, 95% confidence interval (CI): 0.604-0.798, r = 0.654, 95% CI: 0.544-0.765, P < 0.001, respectively). A weak level correlation was observed between liver biopsy, MRI methods, and vibration-controlled transient elastography attenuation parameters in 42 available donors. Based on receiver operating characteristic (ROC) analysis, MRS-PDFF and CS-MRI PDFF significantly distinguished >5% of histopathologically detected hepatic steatosis with an area under the ROC curve (AUC) of 0.837 ± 0.036 (P < 0.001, 95% CI: 0.766-0.907) and 0.810 ± 0.036 (P < 0.001, 95% CI: 0.739-0.881), respectively. The negative predictive values (NPVs) of MRS-PDFF and CS-MRI PDFF were 88.3% and 81.3%, respectively. In terms of distinguishing between clinically significant hepatic steatosis (≥10% on histopathology), the AUC of MRS-PDFF and CS-MRI were 0.871 ± 0.034 (P < 0.001 95% CI: 0.804-0.937) and 0.855 ± 0.036 (P < 0.001, 95% CI: 0.784-0.925), respectively. The NPVs of MRS-PDFF and CS-MRI were 99% and 92%, respectively. CONCLUSION The methods of MRS-PDFF and CS-MRI PDFF provide a non-invasive and accurate approach for assessing hepatic steatosis in potential living liver donor candidates. These MRI PDFF techniques present a promising clinical advantage in the preoperative evaluation of living liver donors by eliminating the requirement for invasive procedures like liver biopsy.
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Affiliation(s)
- Diğdem Kuru Öz
- Ankara University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Zeynep Ellik
- Ankara University Faculty of Medicine, Department of Gastroenterology, Ankara, Türkiye
| | | | - Mehmet Adıgüzel
- Ankara University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Mesut Gümüşsoy
- Ankara University Faculty of Medicine, Department of Gastroenterology, Ankara, Türkiye
| | - Saba Kiremitci
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Türkiye
| | - Onur Elvan Kırımker
- Ankara University Faculty of Medicine, Department of General Surgery, Ankara, Türkiye
| | - Hale Gökcan
- Ankara University Faculty of Medicine, Department of Gastroenterology, Ankara, Türkiye
| | - Atilla Halil Elhan
- Ankara University Faculty of Medicine, Department of Biostatistics, Ankara, Türkiye
| | - Deniz Balcı
- Bahçesehir University Faculty of Medicine, Department of General Surgery, İstanbul, Türkiye
| | - Berna Savaş
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Türkiye
| | - Ayşe Erden
- Ankara University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Ramazan İdilman
- Ankara University Faculty of Medicine, Department of Gastroenterology, Ankara, Türkiye
- Ankara University Hepatology Institute, Ankara, Türkiye
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Tezcan H, Altunsoy A, Turan Gökçe D, Gökcan H, Arı D, Aydın O, Bostancı EB, Akdoğan Kayhan M. Multidrug-Resistant Infections After Liver Transplantation, Etiology and Risk Factors: A Single-Center Experience. EXP CLIN TRANSPLANT 2023; 21:952-960. [PMID: 38263782 DOI: 10.6002/ect.2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Patients undergoing liver transplant are at an increased risk of morbidity and mortality due to the development of infections. We aimed to evaluate the risk factors affecting the incidence of infectious diseases after liver transplant and to present the epidemiological data. MATERIALS AND METHODS We investigated patients aged ≥18 years who underwent liver transplant between 2012 and 2020 at our center. We collected infections, causative microorganisms, and antibacterial resistance patterns seen during the first 6 months posttransplant. Risk factors affecting the development of infectious diseases were also analyzed and evaluated. RESULTS Of 112 patients included in our study, 76 (67.9%) were men, and the median age was 50 years (range, 20-66 years). Within month 1 and month 6 after transplant, at least 1 episode of infection occurred in 67 (59.8%) and 80 (71.4%) patients, respectively. Bacterial infections were the most common type (n = 78, 95.1%), followed by fungal (n = 2, 2.4%) and viral (n = 2, 2.4%) infections. The rate of multidrug resistance in bacterial infections was high (n = 38, 52.7%) and was also a risk factor for mortality in the first 6 months after transplant (P < .001). Pretransplant values of international normalized ratio, creatinine, bilirubin, and posttransplant intensive care unit stay, as well as the presence of encephalopathy, were shown to increase the risk of infection after transplant. CONCLUSIONS Multidrug-resistant bacterial infections are a significant risk factor for mortality in liver transplant patients. Many risk factors that contribute to the development of infections aftertransplant have been included in prognostic scoring systems of liver failure. Consequently, the severity of end-stage liver failure is directly related to the risk of posttransplant infections.
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Affiliation(s)
- Hatice Tezcan
- From the Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
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Yeşil B, Çalışkan AR, Koşar K, Yüksel M, Gökcan H, Tümtürk A, Köseoğlu HT, Akdoğan Kayhan M. Lymphocyte count and NLR as predictive value for the severity of acute cholangitis. Eur Rev Med Pharmacol Sci 2023; 27:8732-8739. [PMID: 37782185 DOI: 10.26355/eurrev_202309_33795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Acute cholangitis is a serious infectious condition in which systemic complications occur and can lead to mortality. In this study, we tried to elucidate the relationship between lymphocyte count and neutrophil-lymphocyte ratio (NLR) with disease severity in patients with acute cholangitis. PATIENTS AND METHODS In this retrospective analysis, 633 patients who met the definitive diagnosis criteria for acute cholangitis were enrolled as the study group. In the same period, 155 patients without acute cholangitis who had normal inflammatory markers and underwent endoscopic retrograde cholangiopancreatography (ERCP) were included in the study as the control group. The lymphocyte count, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) of the acute cholangitis group, the control group, and the acute cholangitis group were compared according to the severity of cholangitis. RESULTS There was a statistically significant correlation between the severity of cholangitis and the degree of lymphocytopenia (p<0.05). It was observed that as the disease severity increased, the proportion of patients with normal lymphocytopenia degree decreased, and abnormal findings increased. It was seen that the NLR and PLR results of the patients increased as the severity of cholangitis increased. CONCLUSIONS As a result, one can conclude that the increase in the severity of cholangitis caused an increase in NLR and PLR and a decrease in lymphocytes. Although the increase in NLR and lymphocytopenia results were considered statistically significant, the increase in PLR was not at an acceptable level.
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Affiliation(s)
- B Yeşil
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey.
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4
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Karakaya MF, Er E, Kırımker O, Gümüşsoy M, Bodakçi E, Özercan M, Doğanay Erdoğan B, Gökcan H, Koloğlu M, Karayalçın K, Yurdaydın C, Tüzüner A, Haznedaroğlu S, Çınar K, Özkan H, Idilman R, Idilman R. Management of Biliary Complications in Liver Transplant Recipients with Duct-To-Duct Anastomosis: A Single-Center Experience. Turk J Gastroenterol 2023; 34:177-181. [PMID: 36843302 PMCID: PMC10081117 DOI: 10.5152/tjg.2023.22724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND The aims of this study were to investigate biliary complications in liver transplant recipients with choledochocholedocho stomy anastomosis, to identify the risk factors for the development of such complications, and to evaluate the success of endoscopic approaches in liver transplant recipients. METHODS Between January 2013 and May 2021, a total of 238 patients with liver diseases underwent liver transplantation: 174 recipients undergoing choledochocholedochostomy anastomosis were included in the analysis. RESULTS Their median age was 54.0 years. The median posttransplant follow-up period was 29 months. Hepatitis B virus infection (33%) was the most common indication for liver transplantation. Most patients (87%) received living donor liver transplantation. The overall prevalence of posttransplant biliary complications was 31%. Anastomotic biliary strictures were the most common biliary complications (72%), followed by biliary leakage (13%). The median time between endoscopic retrograde cholangiography and liver transplantation was 4 months, with a mean of 3 ± 1.6 sessions. Endoscopic retrograde cholangiography-guided drainage and balloon dilation with or without stent placement was the most common treatment modalities for recipients with biliary strictures. The overall success rate of endoscopic treatment modalities was 83.3%, with 65% of the recipients exhibiting complete biochemical and endoscopic responses. The response did not differ significantly between living donor liver transplantation and cadaveric donor liver transplant recipients (P > .05). Three recipients required revision surgery for biliary complication repair. Six patients died due to biliary sepsis. CONCLUSION Biliary stricture and leakages were the most common biliary complications after liver transplantation. Endoscopic treatment was successful in most recipients.
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Affiliation(s)
| | - Erdem Er
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Onur Kırımker
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mesut Gümüşsoy
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emin Bodakçi
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mubin Özercan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Hale Gökcan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koloğlu
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kaan Karayalçın
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Cihan Yurdaydın
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Acar Tüzüner
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Selçuk Haznedaroğlu
- Department of General Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kubilay Çınar
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özkan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
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Arı D, Dağlı M, Gökcan H, Turan Gökçe D, Ökten RS, Aydın O, Kaçar S, Bostancı EB, Akdoğan Kayhan M. Effect of Pretransplant Sarcopenia on Mortality in Liver Transplant Recipients. EXP CLIN TRANSPLANT 2023; 21:123-131. [PMID: 36919720 DOI: 10.6002/ect.2022.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Sarcopenia is an important metabolic disorder associated with end-stage liver disease and is an independent predictor of mortality in liver transplant candidates. We evaluated effects of pretransplant muscle mass, muscle quality, and visceral adipose tissue on mortality after liver transplant. MATERIALS AND METHODS For 2015-2020, we included 65 liver transplant recipients whose records contained pretransplant liver computed tomography images. We calculated skeletal muscle mass index (muscle tissue area in centimeters squared divided by height in meters squared), visceral-to-subcutaneous fat ratio (visceral adiposity indicator), and intramuscular adipose tissue content ratio (muscle quality indicator). RESULTS Median age was 55 years (IQR, 45-63 years), and 48 (73.8%) patients were men. During follow-up, 53 (81.5%) study group patients survived; mean survival time was 71.73 ± 3.81 months. The deceased patient group had a statistically higher pretransplant visceral-to-subcutaneous fat ratio than the survival group (P = .046). Survival was 100% for 1 positive indicator, 86.2% for 2 positive indicators, and 70.4% for 3 positive indicators (P = .096). Positive correlation was confirmed between pretransplant skeletal muscle mass index and age (P = .043) and pretransplant body mass index (weight in kilograms divided by height in meters squared) (P < .001). There was a moderate positive correlation between pretransplant intramuscular adipose tissue content ratio and age (R = 0.529, P ≤ .001) and a weak positive correlation with pretransplant body mass index (R = 0.361, P = .003). Furthermore, pretransplant visceral- tosubcutaneous fat ratio showed a weak positive correlation with age (R = 0.306, P = .013) and a weak negative correlation with the Model for End-Stage Liver Disease score (R = -0.301, P = .016). CONCLUSIONS Pretransplant sarcopenia is an important indicator to predict mortality and morbidity in posttransplant follow-up. Visceral-to-subcutaneous fat ratio is an important parameter to evaluate sarcopenia in liver transplant patients.
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Affiliation(s)
- Derya Arı
- From the Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
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Arı D, Turan D, Gökcan H, Özdemir M, Akdoğan Kayhan M. Complete Recovery After Immunosuppressive Treatment Change in a Patient With Posttransplant Lymphoproliferative Disorder. EXP CLIN TRANSPLANT 2023; 21:76-79. [PMID: 34981706 DOI: 10.6002/ect.2021.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Posttransplant lymphoproliferative diseases are a rare but important cause of morbidity and mortality secondary to immunosuppression after solid-organ or bone marrow transplant. Generally, posttransplant lymphoproliferative diseases develop in the first 2 years after transplant, when immunosuppressive therapy is the most intense. Change or reduction in immunosup - pressive treatment is an option for treatment of posttransplant lymphoproliferative diseases. We evaluated the treatment of a patient with posttransplant lymphoproliferative disease after liver transplant. A 64-year-old man underwent liver transplant from a living donor (the patient's son) in 2011 to treat hepatocellular cancer secondary to chronic hepatitis B. Tacrolimus and mycophenolate mofetil were used for immunosuppression through 9 years after liver transplant. In the abdominal computed tomography performed in response to abdominal pain during follow-up in March 2019, multiple solid lesions were observed. A liver biopsy revealed posttransplant lymphoproliferative disease with diffuse large B-cell lymphoma. Fluorine-18 positron emission tomography/computed tomography imaging of the patient showed no pathology in favor of primary lymphoproliferative disease. Mycophenolate mofetil and tacrolimus treatment was changed to everolimus. In the follow-up dynamic magnetic resonance imaging examination that was performed at 3 months after treatment change, we observed that the lesion at liver segment 6 had regressed to 30 mm and several lesions with similar features were observed in the right lobe of the liver. Additional liver biopsy results were compatible with complete remission. The patient's clinical symptoms had fully regressed at 18 months after the diagnosis of PTLD, at the time of this writing. Ongoing radiological and clinical follow-up has shown complete remission. Change from calcineurin treatment to treatment with an inhibitor of the mechanistic target of rapamycin may be an essential and new option for treatment of posttransplant lymphoproliferative disease after liver transplant.
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Affiliation(s)
- Derya Arı
- From the Ankara City Hospital, Department of Gastroenterology, Ankara, Turkey
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7
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Bacaksız F, Gökcan H, Akdoğan M, Gökçe DT, Arı D, Gökbulut V, Ergün Y, Öztürk Ö, Kacar S. Role of hepatosteatosis in HBsAg seroconversion in HBeAg-negative chronic hepatitis B patients. Int J Clin Pract 2021; 75:e14899. [PMID: 34547163 DOI: 10.1111/ijcp.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In chronic Hepatitis B virus (HBV) infection, certain individual and viral characteristics such as advanced age, presence of hepatic steatosis (HS), normal ALT levels, initially negative HBeAg and HBV DNA, and genotype of the virus are associated with HBsAg seroclearance and seroconversion. Herein, we report the results of our study evaluating the association between hepatosteatosis and HbsAg seroconversion. METHODS The clinical and biochemical data of patients with CHB and hepatosteatosis (HS) (HBsAg seroconversion, n:52, and non-HbsAg seroconversion, n:352), and the rate of development of HBsAg seroconversion were evaluated. RESULTS We collected data from 404 patients with HBeAg negative CBH (mean age ± SD: 36.2 ± 11 years; 223 [55.2%] men, 181 [44.8%] women). The mean age at diagnosis of disease was 36.2 ± 11 years. The mean duration of the disease was 10.6 ± 7 years. Seroconversion developed in 52 patients (12.8%) with serum HBsAg positive (mean ± SD: 12.7 ± 5.8). Elderly age and the duration of disease time were significantly associated with seroconversion (P < .001). The presence of serum HBsAg seroconversion was significantly associated with hepatosteatosis (OR: 3.06, 95% CI 1.64-5.71, P < .01). Serum HBsAg seroconversion was more frequent in patients with mild HS than patients with moderate-severe HS (P = .04). In multivariate regression analysis, the presence of HS was found to be an independent factor predicting the development of HBsAg seroconversion (OR: 2.07 95% GA:1.07-4.0 P = .03). CONCLUSION The presence of mild HS in HBeAg negative chronic hepatitis B patients contributes to HBsAg seroconversion. Further studies are required to better understand the relationship between steatosis and HBsAg seroconversion.
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Affiliation(s)
- Ferhat Bacaksız
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Hale Gökcan
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Meral Akdoğan
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | | | - Derya Arı
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Volkan Gökbulut
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Yakup Ergün
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Ömer Öztürk
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Sabite Kacar
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
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Gökcan H. Covering the Cover. Turk J Gastroenterol 2018; 29:526-529. [PMID: 30260772 DOI: 10.5152/tjg.2018.270818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kaplan M, Ateş I, Gökcan H, Kayhan MA, Kaçar S, Akpınar MY, Gökbulut V, Kayaçetin E. Prognostic Utility of Hypokalemia in Cirrhotic Patients. Acta Gastroenterol Belg 2018; 81:398-403. [PMID: 30350528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIM We researched the relationships between serum potassium level and prognostic scores and complications of cirrhosis, and mortality. METHODS This study was performed retrospectively in Turkish High Specialty Training and Research Hospital between 2009 and 2015. Patients who had missing patient files and electrolyte disorder for another reason, showed complications at the time of application and were using diuretics were excluded from the study. RESULTS 218 patients were included in the study. During the follow-up period, 23.4% (n: 51) of the entire population passed away. Compared to the patients who survived, the patients who passed away had higher HCC and HES development rate, mean Child-Pugh and MELD score and lower mean blood potassium level. The stepwise multivariable Cox regression model which included significant independent predictors showed that ChildPugh score (HR: 1.29; p <0.001), MELD score (HR:1.13; p= 0.006), and potassium level (HR: 0.18; p< 0.001) were independent predictors of mortality. The cut off value for potassium level in predicting mortality was found to be ≤ 3.4 mmol/L with 80.4% sensitivity and 100% specificity. Compared to the patients with a potassium level > 3.4 mmol/L, the patients with a potassium level ≤ 3.4 mmol/L had higher mortality rate, HCC and HES development rate, mean Child-Pugh and mean MELD scores. CONCLUSION Hypokalemia is an important prognostic factor in cirrhotic patients.
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Affiliation(s)
- M Kaplan
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - I Ateş
- Ankara Numune Training and Research Hospital, Department of Internal Medicine, Ankara, Turkey
| | - H Gökcan
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - M A Kayhan
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - S Kaçar
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - M Y Akpınar
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - V Gökbulut
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - E Kayaçetin
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
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Abstract
Tacrolimus and cyclosporin are calcineurin inhibitors (CIs) commonly used in organ transplants. These agents rarely cause a severe, debilitating pain syndrome of especially lower extremities, known as CI pain syndrome (CIPS). Although the pathogenesis is not well understood, neuropathic pain mechanisms have started to be discussed in the recent literature. Here, presenting a 48-year-old male with CIPS who recovered after pregabalin 150 mg twice daily, we aimed to emphasize the importance of this syndrome and offer a new approach for the treatment. This is the first report in the literature where pregabalin is demonstrated to be effective in CIPS.
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Affiliation(s)
- Özlem Taşoğlu
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Hale Gökcan
- Department of Gastroenterology, Ankara Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Sibel Özbudak Demir
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Didem Yenigün
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Meral Akdoğan
- Department of Gastroenterology, Ankara Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Sabite Kaçar
- Department of Gastroenterology, Ankara Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
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Gökcan H, Kuzu UB, Öztaş E, Saygılı F, Öztuna D, Suna N, Tenlik İ, Akdoğan M, Kaçar S, Kılıç ZMY, Kayaçetin E. The predictive value of noninvasive serum markers of liver fibrosis in patients with chronic hepatitis C. Turk J Gastroenterol 2016; 27:156-64. [PMID: 26853790 DOI: 10.5152/tjg.2015.150449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS This study aims to show the predictive value of noninvasive serum markers on the hepatic fibrosis level. MATERIALS AND METHODS This cross sectional study involves 120 patients with chronic hepatitis C. The noninvasive markers used were as follows: age-platelet index (AP index), cirrhosis discriminant score (CDS), aspartate aminotransferase (AST)-alanine aminotransferase (ALT) ratio (AAR), fibrosis-4 (FIB-4) index, AST-platelet ratio index (APRI), Goteborg University Cirrhosis Index (GUCI), FibroQ, King's score, platelet count. Concurrent liver biopsies were evaluated using the modified Ishak and Knodell scoring systems. In accordance with the Knodell scores, F3-F4 scores were defined as "severe fibrosis," and the modified Ishak scores stage of ≥3 (F3-F6) were defined as "clinically significant fibrosis." Receiver Operating Characteristic (ROC) curve analyses were carried out to compare the noninvasive markers with hepatic fibrosis level. RESULTS Mean age of the patients was 51.7±11.6. A total of 10 patients (8.3%) with Knodell scores and 24 patients (20%) with modified Ishak scores were evaluated to have ≥F3 hepatic fibrosis. ROC analyses with the Knodell and modified Ishak scores were as follows: AP index=0.61-0.57, CDS=0.66-0.55, AAR=0.60-0.49, FIB-4=0.70-0.68, APRI=0.67-0.72, GUCI=0.66-0.72, FibroQ=0.64-0.54, King's score=0.68-0.54, platelet count=0.61-0.55. CONCLUSION We found that APRI, FIB-4, King's score, and GUCI can be used to determination patients with mild fibrosis with a high negative predictive value and in the differentiation of severe/significant fibrosis from mild to moderate fibrosis.
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Affiliation(s)
- Hale Gökcan
- Department of Gastroenterology, Ankara Yüksek İhtisas Research and Training Hospital, Ankara, Turkey.
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Gökcan H, Selçuk H, Töre E, Gülseren P, Cambaz H, Sarıtaş Ş, Öcal R, Başaran Ö, Yılmaz U, Akın E. The Nutritional Risk Screening 2002 tool for detecting malnutrition risk in hospitalised patients: perspective from a developing country. Turk J Gastroenterol 2015; 25:718-23. [PMID: 25599788 DOI: 10.5152/tjg.2014.6651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS To verify the validity of the Nutritional Risk Screening (NRS) 2002 test in a Turkish population. MATERIALS AND METHODS We prospectively investigated 2566 patients at a tertiary referral hospital. Nutritional status was screened using NRS 2002, and the length of the stay (LOS) was the main outcome measure. Hospital stays >10 days were accepted as prolonged LOS. NRS scores ≥3 were accepted as indicating risk for malnutrition. Statistical analyses were performed to determine the independent risk factors for malnutrition risk and prolonged LOS. RESULTS The mean age of patients was 56.6±16.9 years. According to the NRS 2002, 964 patients (37.6%) were without risk, 1320 (51.4%) warranted surveillance and 282 (11%) were at high risk for malnutrition. Malnutrition rate was the highest in the intensive care unit (22.01%). Prolonged LOS was seen in 24.4% of patients. Intensive care unit stay [odds ratio (OR): 0.585; confidence interval (CI): 1.45-2.22; p<0.001] and an NRS score ≥3 (OR: 0.88; CI: 1.87-3.13; p<0.001) were independent risk factors for prolonged LOS. CONCLUSION Improving healthcare outcomes while avoiding preventable healthcare costs is an important goal of healthcare provision in developing countries. NRS 2002 was predictive of LOS, and thus, of patient prognosis. Further community-based studies are warranted to assess the impact of NRS 2002 on reducing healthcare costs.
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Affiliation(s)
- Hale Gökcan
- Department of Gastroenterology and Hepatology, Dr. Abdurrahman Yurtaaslan Oncology Research and Training Hospital, Ankara, Turkey.
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Durak AT, Gökcan H, Konuklar FAS. Theoretical studies on the inactivation mechanism of γ-aminobutyric acid aminotransferase. Org Biomol Chem 2011; 9:5162-71. [DOI: 10.1039/c1ob05146f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gökcan H, Uruç I, Selçuk H, Savaş N, Yilmaz U. A case of eosinophilic gastritis secondary to ulcerative colitis. Turk J Gastroenterol 2010; 21:69-70. [PMID: 20533119 DOI: 10.4318/tjg.2010.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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