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Akbulut S, Yagin FH, Sahin TT, Garzali IU, Tuncer A, Akyuz M, Bagci N, Barut B, Unsal S, Sarici KB, Saritas S, Ozer A, Bentli R, Colak C, Bayindir Y, Yilmaz S. Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation: Retrospective Cohort Study. J Clin Med 2023; 12:4466. [PMID: 37445501 DOI: 10.3390/jcm12134466] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In liver transplant (LT) recipients, immunosuppressive therapy may potentially increase the risk of severe COVID-19 and may increase the mortality in patients. However, studies have shown conflicting results, with various studies reporting poor outcomes while the others show no difference between the LT recipients and healthy population. The aim of this study is to determine the impact of the COVID-19 pandemic on survival of LT recipients. METHODS This is a retrospective cohort study analyzing the data from 387 LT recipients diagnosed with COVID-19. LT recipients were divided into two groups: survival (n = 359) and non-survival (n = 28) groups. A logistic regression model was used to determine the independent risk factors for mortality. Machine learning models were used to analyze the contribution of independent variables to the mortality in LT recipients. RESULTS The COVID-19-related mortality rate in LT recipients was 7.2%. Multivariate analysis showed that everolimus use (p = 0.012; OR = 6.2), need for intubation (p = 0.001; OR = 38.4) and discontinuation of immunosuppressive therapy (p = 0.047; OR = 7.3) were independent risk factors for mortality. Furthermore, COVID-19 vaccination reduced the risk of mortality by 100 fold and was the single independent factor determining the survival of the LT recipients. CONCLUSION The effect of COVID-19 infection on LT recipients is slightly different from the effect of the disease on the general population. The COVID-19-related mortality is lower than the general population and vaccination for COVID-19 significantly reduces the risk of mortality.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Ibrahim Umar Garzali
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Surgery, Aminu Kano Teaching Hospital, Kano 700101, Nigeria
| | - Adem Tuncer
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Musap Akyuz
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Nazlican Bagci
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Bora Barut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Kemal Baris Sarici
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Serdar Saritas
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Ali Ozer
- Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Recep Bentli
- Department of Internal Medicine, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Yasar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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Akbulut S, Tamer M, Saritas S, Unal O, Akyuz M, Unsal S, Kucukakcali Z, Karabulut E, Usta S, Yilmaz S. Immunosuppressive Medication Adherence in Patients With Hepatocellular Cancer Who Have Undergo Liver Transplantation: A Case Control Study. Transplant Proc 2023:S0041-1345(23)00164-1. [PMID: 37080874 DOI: 10.1016/j.transproceed.2023.02.064] [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] [Received: 11/22/2022] [Revised: 01/08/2023] [Accepted: 02/22/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND We aimed to compare the adherence to immunosuppressive medication use in patients who underwent liver transplantation (LT) due to hepatocellular carcinoma (HCC) and non-HCC reasons. METHODS The study population was determined as 242 patients with HCC and 1290 patients with non-HCC who had LT performed in our institute between March 2002 and November 2021; all these patients were contacted by phone in March 2022. The sample size was calculated using the MedCalc software program, and the number of patients required in each group was determined as 111 patients. Furthermore, we used the sample.int function, a random integer generator in the R (version 4.1.2) software program. Whereas demographic and clinical parameters were determined as independent variables, the immunosuppressive medication adherence scale (IMAS) score was determined as a dependent variable. Patients were evaluated by the IMAS. This 11-item IMAS scale evaluates the lowest compliance score as 11 and the highest as 55. RESULTS Out of a total number of 221 patients, 161 (72%) were men and 60 (27.1%) were women, with a median age of 58 years (IQR: 14); one patient in the non-HCC group was excluded due to lack of data. Among the HCC and non-HCC groups, significant differences were found in terms of the variables of age (P = .003), IMAS score (P < .001), sex (P = .001), working status (P = .004), chronic diseases (P = .008), tacrolimus alone (P < .001), tacrolimus plus everolimus (P < .001), and often medication changes (P < .001). A statistically significant correlation was found between the IMAS score and whether the patients had HCC (P < .001) and frequently changing immunosuppressive drugs (P = .023). CONCLUSION This study showed that patients with frequent drug changes or non-HCC etiology had better adherence to immunosuppressive drug use.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department of Public Health, Inonu University Faculty of Medicine, Malatya, Turkey; Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Murat Tamer
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya, Turkey
| | - Serdar Saritas
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya, Turkey
| | - Ozlem Unal
- Department of Internal Medicine Nursing, Inonu University Faculty of Nursing, Malatya, Turkey
| | - Musap Akyuz
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Zeynep Kucukakcali
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ertugrul Karabulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sertac Usta
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Akbulut S, Kucukakcali Z, Saritas H, Bozkir C, Tamer M, Akyuz M, Bagci N, Unsal S, Akbulut MS, Sahin TT, Colak C, Yilmaz S. Effect of the COVID-19 Pandemic on the Psychological Health of Patients Who Underwent Liver Transplantation Due to Hepatocellular Carcinoma. Diagnostics (Basel) 2023; 13:diagnostics13081410. [PMID: 37189511 DOI: 10.3390/diagnostics13081410] [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] [Received: 02/19/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress. METHOD A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case-control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine. RESULTS Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total (p < 0.001) and CAS-SF (p = 0.002) scores. Cronbach's alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively. CONCLUSION This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
- Department of Public Health, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
- Department of Biostatistics, Bioinformatics and Medical Informatics, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Zeynep Kucukakcali
- Department of Biostatistics, Bioinformatics and Medical Informatics, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Hasan Saritas
- Department of Surgical Nursing, Siirt University Faculty of Health Science, 56100 Siirt, Turkey
| | - Cigdem Bozkir
- Department of Nutrition and Dietetics, Inonu University Faculty of Health Science, 44280 Malatya, Turkey
| | - Murat Tamer
- Department of Surgical Nursing, Inonu University Faculty of Nursing, 44280 Malatya, Turkey
| | - Musap Akyuz
- Department of Surgical Nursing, Inonu University Faculty of Nursing, 44280 Malatya, Turkey
| | - Nazlican Bagci
- Department of Surgical Nursing, Inonu University Faculty of Nursing, 44280 Malatya, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | | | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Cemil Colak
- Department of Biostatistics, Bioinformatics and Medical Informatics, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
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Akbulut S, Barut B, Garzali IU, Sarici KB, Tamer M, Unsal S, Karabulut E, Baskiran A, Bayindir Y, Yilmaz S. Effect of Pre-Transplant COVID-19 Exposure On Post-Liver Transplant Clinical Outcomes. Transplant Proc 2023:S0041-1345(23)00089-1. [PMID: 36973149 PMCID: PMC9968604 DOI: 10.1016/j.transproceed.2023.01.024] [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] [Received: 10/14/2022] [Revised: 11/21/2022] [Accepted: 01/04/2023] [Indexed: 03/01/2023]
Abstract
Background and Aim COVID-19 has led to an unprecedented global health crisis. This situation caused an immediate reduction in solid organ transplantation activity. The aim of this study was to present the follow-up results of patients with chronic liver disease (CLD) who underwent LT after a previous history of COVID-19 infection. Methods Socio-demographic characteristics and clinicopathological data of 474 patients who underwent LT at Inonu University Liver Transplant Institute between March 11, 2020, and March 17, 2022, were prospectively recorded and analyzed retrospectively. Among these, the data of 35 patients with CLD who were found to be exposed to COVID-19 infection in the pre-LT period were analyzed for this study. Results The median BMI, Child, and MELD/PELD scores of the 35 patients were calculated as 25.1 kg/m2 (IQR: 7.4), 9 (IQR: 4) and 16 (IQR: 10), respectively. Graft rejection occurred in four patients at a median of 25 days post-transplant. Five patients underwent retransplantation at median 25 days post-transplant. The most common cause of retransplantation is early hepatic artery thrombosis. There were 5 deaths during postoperative follow up. Mortality developed in 5 (14.3%) of the patients who were exposed to COVID-19 infection in the pre-transplant period, while mortality occurred in 56 (12.8%) of the patients who were not exposed to COVID-19 infection. There was no statistically significant difference in mortality between the groups (p=0.79). Conclusion The results of this study showed that exposure to COVID-19 before LT does not affect post-transplant patients and graft survival.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Bora Barut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | | | - Kemal Baris Sarici
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Murat Tamer
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ertugrul Karabulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adil Baskiran
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yasar Bayindir
- and Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Akbulut S, Demyati K, Toman I, Gaygili Z, Kaya S, Akpolat VR, Cing A, Keles TY, Saritas H, Unsal S, Ozer A. Medical students' knowledge, attitudes and awareness toward organ donation. Transpl Immunol 2022; 73:101634. [PMID: 35623595 DOI: 10.1016/j.trim.2022.101634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This survey study aimed to evaluate medical students' attitudes, knowledge, and awareness toward organ donation. METHODS For this questionnaire-based cross-sectional study, 1000 medical students were interviewed, out of which 950 students agreed to participate in the study and were enrolled. A questionnaire form consisting of 29 questions was used to determine the students' socio-demographic characteristics and rate their knowledge, attitudes, and behaviors about organ donation. RESULTS While 95.5% (n = 907) of the students stated that they had not donated organs, 41.1% stated that they had not yet decided to donate organs, and 59.7% stated that they had no specific reason for them not donating organs. Out of the participants, 68.1% stated that organ donation complies with the Islamic rules; 40.7% stated that the Directorate of Religious Affairs issued a fatwa on organ donation, and 39.4% stated that there are legal regulations on organ donation in the country. While 22.1% of the students stated that a person with brain death could come back to life, 19.7% stated that they did not know about this issue. The students who had donated organs and who did not show significant differences regarding the answers given to the questions about whether organ donation complies with religious rules (p < 0.001), where one must apply to donate organs (p = 0.032), the will to donate the organs of a relative with brain death (p = 0.004), and whether preaching in mosques and foundations is needed to increase organ donation rates (p = 0.042). Although there was a correlation between the students' grade and their attitude and knowledge about organ donation, this correlation was weak and showed no parallelism with increasing grades. CONCLUSION This study indicates that medical students have inadequate knowledge, attitudes, and behaviors about organ donation. In our opinion, it is of paramount importance to provide physician candidates, who should set an example for society, with periodic training on organ donation throughout their academic life in shaping the national organ donation policy in the future.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
| | - Khaled Demyati
- Department of Surgery, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Irem Toman
- Medical Students, Inonu University, Faculty of Medicine, 44280 Malatya, Turkey
| | - Zeynep Gaygili
- Medical Students, Inonu University, Faculty of Medicine, 44280 Malatya, Turkey
| | - Semih Kaya
- Medical Students, Inonu University, Faculty of Medicine, 44280 Malatya, Turkey
| | - Vildan Rana Akpolat
- Medical Students, Inonu University, Faculty of Medicine, 44280 Malatya, Turkey
| | - Ayla Cing
- Medical Students, Inonu University, Faculty of Medicine, 44280 Malatya, Turkey
| | - Taha Yasin Keles
- Medical Students, Inonu University, Faculty of Medicine, 44280 Malatya, Turkey
| | - Hasan Saritas
- Department of Surgical Nursing, Inonu University Faculty of Nursing, 44280 Malatya, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Ali Ozer
- Department of Public Health, Inonu University, Faculty of Medicine, 44280 Malatya, Turkey
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Akbulut S, Caliskan AR, Saritas H, Demyati K, Bilgic Y, Unsal S, Koc C, Yilmaz S. Analysis of risk factors affecting the development of peptic ulcer perforation: case-control study. Prz Gastroenterol 2021; 16:23-28. [PMID: 33986884 PMCID: PMC8112271 DOI: 10.5114/pg.2020.94744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
AIM The aim of the to determine the risk factors associated with increased risk of peptic ulcer perforation (PUP). MATERIAL AND METHODS The demographic, clinic, and biochemical parameters of 65 patients (PUP group) who underwent PUP surgery at our clinic between June 2009 and September 2016 were compared with the data of 134 patients (control group) who underwent endoscopy at a gastroenterology clinic for dyspeptic complaints. The control group were matched at random in a 1 : 2 ratio with the PUP group. Univariate analyses were used to compare different variables and variables with clinical significance, and p ≤ 0.05 was used in the backward stepwise logistic regression model. RESULTS This study included 65 patients with peptic ulcer perforation aged 17 to 92 years (PUP group) and 134 patients with dyspeptic complaints aged 18 to 87 years (control group). Univariate analysis showed that statistically significant differences were found between groups in terms of non-steroidal anti-inflammatory drugs usage (p = 0.042; OR = 1.868), smoking (p < 0.001; OR = 5.124), old age (p = 0.003), low body mass index (BMI) (p < 0.001), and low hemoglobin (Hb) (p = 0.002). However multivariate analysis showed that increasing age (p = 0.004; OR = 1.035), smoking (p = 0.007; OR = 3.591), decreasing Hb (p = 0.042; OR = 1.277), and decreasing BMI (p < 0.001; OR = 1.669) were independent clinically significant risk factors for development of PUP. CONCLUSIONS This study showed that decreased BMI, decreased Hb, increased age, and smoking were independent risk factors for development of PUP. Thus, this group of patients needs particular attention paid to suggestive symptoms with early diagnosis and optimal management of peptic ulcer disease.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
- Address for correspondence: Assoc Prof. Sami Akbulut FACS, Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Elazig Yolu 10. Km, Malatya 44280, Turkey, phone: +90 422-3410660, fax: +90 422-3410036, e-mail:
| | - Ali Riza Caliskan
- Department of Gastroenterology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Hasan Saritas
- Department of Surgical Nursing, Faculty of Health Sciences, Inonu University, Malatya, Turkey
| | - Khaled Demyati
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
- Department of Surgery, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Yilmaz Bilgic
- Department of Gastroenterology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University, Malatya, Turkey
| | - Cemalettin Koc
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
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Akbulut S, Ozdemir E, Samdanci E, Unsal S, Harputluoglu M, Yilmaz S. Fascioliasis presenting as colon cancer liver metastasis on 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A case report. World J Hepatol 2019; 11:656-662. [PMID: 31528248 PMCID: PMC6717711 DOI: 10.4254/wjh.v11.i8.656] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/20/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fascioliasis is caused by watercress and similar freshwater plants or drinking water or beverages contaminated with metacercariae. Fascioliasis can radiologically mimic many primary or metastatic liver tumors. Herein, we aimed to present the treatment process of a patient with fascioliasis mimicking colon cancer liver metastasis.
CASE SUMMARY A 35-year-old woman who underwent right hemicolectomy due to cecum cancer was referred to our clinic for management of colon cancer liver metastasis. Both computed tomography and 18F-fluorodeoxyglucose positron emission tomography revealed several tumoral lesions localized in the right lobe of the liver. After a 6-course FOLFOX (folinic acid, fluorouracil, oxaliplatin) and bevacizumab regimen, the hypermetabolic state on both liver and abdominal lymph nodes continued, and chemotherapy was extended to a 12-course regimen. The patient was referred to our institute when the liver lesions were detected to be larger on dynamic liver magnetic resonance imaging 6 weeks after completion of chemotherapy. Right hepatectomy was performed, and histopathological examination was compatible with fascioliasis. Fasciola hepatica IgG enzyme-linked immunosorbent assay was positive. The patient was administered two doses of triclabendazole (10 mg/kg/dose) 24 h apart. During the follow-up period, dilatation was detected in the common bile duct, and Fasciola parasites were extracted from the common bile duct by endoscopic retrograde cholangiopancreatography (ERCP). Triclabendazole was administered to the patient after ERCP.
CONCLUSION Parasitic diseases, such as those caused by Fasciola hepatica, should be kept in mind in the differential diagnosis of primary or metastatic liver tumors, such as colorectal cancer liver metastasis, in patients living in endemic areas.
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Affiliation(s)
- Sami Akbulut
- Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
| | - Egemen Ozdemir
- Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Emine Samdanci
- Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Selver Unsal
- Department of Nursing Service, Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
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Unsal S, Ozkara A, Albayrak T, Ozturk Y, Beysel S, Kucukler FK. Evaluation of prehypertension and masked hypertension rate among clinically normotensive patients. Clin Exp Hypertens 2016; 38:218-24. [PMID: 26818410 DOI: 10.3109/10641963.2015.1047951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/13/2022]
Abstract
BACKGROUND The present cross-sectional study was aimed to identify pre-hypertension and masked hypertension rate in clinically normotensive adults in relation to socio-demographic, clinical and laboratory parameters. METHODS A total of 161 clinically normotensive adults with office blood pressure (OBP) <140/90 mmHg without medication were included in this single-center cross-sectional study. OBP, home BP (HBP) recordings and ambulatory BP monitoring (ABPM) were used to identify rates of true normotensives, true pre-hypertensives and masked hypertensives. Data on sociodemographic and clinical characteristics were collected in each subject and evaluated with respect to true normotensive vs. pre-hypertensive patients with masked hypertension or true pre-hypertensive. Target organ damage (TOD) was evaluated in masked hypertensives based on laboratory investigation. RESULTS Masked hypertension was identified in 8.7% of clinically normotensives. Alcohol consumption was significantly more common in masked hypertension than in true pre-hypertension (28.6 vs. 0.0%, p = 0.020) with risk ratio of 2.7 (95% CI 1.7-4.4). Patients with true pre-hypertension and masked hypertension had significantly higher values for body mass index, waist circumference, systolic and diastolic OBP and HBP (p < 0.05 for each) compared to true normotensive subjects. ABPM revealed significantly higher values for day-time and night-time systolic and diastolic BP (p = 0.002 for night-time diastolic BP, p < 0.001 for others) in masked hypertension than true pre-hypertension. CONCLUSIONS Given that the associations of pre-hypertension with TOD might be attributable to the high prevalence of insidious presentation of masked hypertension among pre-hypertensive individuals, ABPM seems helpful in early identification and management of masked hypertension in the pre-hypertensive population.
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Affiliation(s)
- S Unsal
- a Department of Family Medicine , Cankiri Public Hospital , Cankiri , Turkey
| | - A Ozkara
- b Department of Family Medicine , Hitit University , Corum , Turkey .,c Department of Family Medicine , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - T Albayrak
- c Department of Family Medicine , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Y Ozturk
- d Department of Biochemistry , Gazi University Medical Faculty Hospital , Ankara , Turkey
| | - S Beysel
- e Department of Endocrinology and Metabolism , Diskapi Yildirim Beyazit Training and Research Hospital , Ankara , Turkey , and
| | - F K Kucukler
- f Department of Endocrinology and Metabolism , Hitit University , Corum , Turkey
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Yuncu G, Ceylan KC, Sevinc S, Ucvet A, Kaya SO, Kiter G, Unsal S, Ozsinan F. [Functional results of surgical treatment of bronchiectasis in a developing country]. Arch Bronconeumol 2006; 42:183-8. [PMID: 16735015 DOI: 10.1016/s1579-2129(06)60440-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/22/2022]
Abstract
BACKGROUND The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important part in thoracic surgery practice in developing countries such as Turkey. This study was designed to evaluate the outcomes of surgical treatment for bronchiectasis, particularly in aspects related to the effects on functional well-being. PATIENTS AND METHOD From January 1995 through December 2003, operations for bronchiectasis were performed in 81 patients. Demographic features, type of resection, and operative morbidity and mortality were evaluated. The outcomes related to overall "social" or nonpulmonary functional status were classified and compared according to a scale constructed to assess patients' well-being preoperatively and at the 6th postoperative month. RESULTS The mean age was 24.4 years and 47 patients (58%) were male. Surgical treatment was lobectomy in 37 (45%), pneumonectomy in 10 (12%), segmentectomy in 13 (16%), and lobectomy plus segmentectomy in 22 (27%) of the operations. Complete resection of disease was achieved in 69 patients (85%). There was no operative mortality. The rate of morbidity was 18.3%. Improvement to a functional status of excellent was observed in 81.7% and improvement to a status of good was seen in 12.7% of patients; 5.6% experienced no change. The results of complete resection were significantly better than those of incomplete resection (P=.0015). CONCLUSION Functional results of surgical treatment for bronchiectasis in this series suggest that the outcomes are favorable and promising, particularly in selected patients with sufficient pulmonary reserves and localized disease who are suitable for complete resection.
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Affiliation(s)
- G Yuncu
- Thoracic Surgery Department, Pamukkale University Medical School, Denizli, Turkey.
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Yuncu G, Ceylan K, Sevinc S, Ucvet A, Kaya S, Kiter G, Unsal S, Ozsinan F. Resultados funcionales del tratamiento quirúrgico de las bronquiectasias en un país en vías de desarrollo. Arch Bronconeumol 2006. [DOI: 10.1157/13086624] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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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Ucvet A, Yuncu G, Sevinc S, Ceylan K, Yaldýz S, Unsal S, Ozsinan F, Kul C. P-640 Surgery therapy in elderly patients with NSCLC. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ercan MT, Gülaldi NC, Uysal U, Unsal S, Aydin M, Peksoy I, Hasçelik Z. Accumulation of 99mTc-Cysteine in experimental inflammatory lesions in comparison to 99mTc-glutamine and 99mTc-HIG. Nuklearmedizin 1997; 36:265-9. [PMID: 17068876] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM The aim of this experimental work was to investigate the efficacy of 99mTc-L-Cysteine (Cys) in scintigraphic visualization of inflammatory lesions in comparison to 99mTc-L-glutamine (G), and 99mTc-HIG. METHODS In mice abscesses were induced by intramuscular injection of turpentine. Six days later mice were injected with 3.7 MBq of each agent and sacrificed in groups of three at 1, 3, 6 and 24 h. Scintigrams were obtained with a gamma camera. The organs, some blood, abscesses, some muscle and urine were removed, weighed and counted in a gamma counter. Percentage of uptake by organs and per gram tissues and abscess/normal tissue concentration ratios were calculated. Experimental arthritis was produced in 6 New Zealand rabbits by intraarticular injection of ovalbumin. Four days later 37 MBq of 99mTc-Cys and 99mTc-HIG were each i.v. administered to 3 rabbits. Scintigrams obtained at 1, 3, 6, and 24 h demonstrated the arthritic joints very well. ROI's over arthritic joints were compared to contralateral normal joints (A/C). RESULTS In mice the abscesses were well visualized on all scintigrams. The maximum abscess/muscle ratios were 5.21 +/- 1.09 (6 h), 3.73 +/- 0.81 (3 h) and 5.98 +/- 1.17 (24 h) and the maximum abscess/blood ratios were 3.46 +/- 1.33 (24 h), 1.81 +/- 0.10 (6 h) and 0.914 +/- 0.351 (24 h) for 99mTc-Cys, 99mTc-G, and 99mTc-HIG, respectively. In rabbits the maximum A/C ratios were 2.61 +/- 0.53 (3 h) and 2.92 +/- 0.99 (24 h) for 99mTc-Cys and 99mTc-HIG, respectively. CONCLUSION Our results indicate that 99mTc-Cys is a promising agent for imaging inflammatory lesions. It is preferred to 99mTc-HIG, because of higher concentration ratios attained earlier, lower blood background, lower cost and a simpler in-house preparation method.
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Affiliation(s)
- M T Ercan
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Yalcintas MG, Jones TD, Meyer HR, Ozer H, Unsal S. Estimation of dose due to accidental exposure to a 60Co therapy source. Health Phys 1980; 38:187-191. [PMID: 7372482 DOI: 10.1097/00004032-198002000-00006] [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: 05/21/2023]
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