The efficacy and tolerability of glecaprevir/pibrentasvir treatment in a real-world chronic hepatitis C patients cohort

Background and Aim

The aims of the present study were to evaluate the real-life efficacy and tolerability of glecaprevir (GLE)/pibrentasvir (PIB) in the treatment of patients with chronic hepatitis C (CHC).

Materials and Methods

Between May 2019 and May 2022, 686 patients with CHC, treated with GLE/PIB combination from 21 participating centers in Turkiye, were enrolled in the study.

Results

All patients were Caucasian, and their median age was 56 years. At the start of GLE/PIB treatment, the median serum Hepatitis C virus RNA and serum alanine amino transaminase (ALT) levels were 6.74 log10 IU/mL and 47 U/L, respectively. Fifty-three percent of the patients were infected with genotype 1b, followed by genotype 3 (17%). Diabetes was the more common concomitant disease. The sustained virological response (SVR12) was 91.4% with intent-to-treat analysis and 98.5% with per protocol analysis. The SVR12 rates were statistically significant differences between the patients who were i.v. drug users and non-user (88.0% vs. 98.8%, p=0.025). From the baseline to SVR12, the serum ALT levels and Model for End-Stage Liver Disease score were significantly improved (p<0.001 and p=0.014, respectively). No severe adverse effect was observed.

Conclusion

GLE/PIB is an effective and tolerable treatment in patients with CHC.

Predictive value of Tp-e interval, Tp-e/QT, and Tp-e/QTc for disease severity in patients with liver cirrhosis

OBJECTIVE

The cardiovascular system is one of the most affected systems in the liver cirrhosis (LC) process, especially due to the tendency to arrhythmia. Since the data about the relationship between LC and novel electrocardiography (ECG) indexes are lacking, we aimed to investigate the association between LC and Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio.

PATIENTS AND METHODS

The study included 100 patients in the study group (56 male, median age 60) and 100 in the control group (52 female, 60 median age) between January 2021 and January 2022. ECG indexes and laboratory findings were analyzed.

RESULTS

The patient group had significantly higher heart rate (HR), Tp-e, Tp-e/QT, and Tp-e/QTc compared to the control group (p < 0.001 for all). There was no difference in terms of QT, QTc, QRS (depolarization of ventricles, involving Q, R, and S waves on ECG) duration, and ejection fraction between the two groups. Kruskal-Wallis test results revealed that there was a significant difference between Child stages in terms of HR, QT, QTc, Tp-e, Tp-e/QT, Tp-e/QTc, and QRS duration. There was also a significant difference between the model for end-stage liver disease (MELD) score groups in terms of all these parameters except for Tp-e/QTc. In the ROC analyses of Tp-e, Tp-e/QT and Tp-e/QTc to predict the Child C, the AUC values were 0.887; (95% CI: 0.853-0.921), 0.730; (95% CI: 0.680-0.780), and 0.670; (95% CI: 0.614-0.726), respectively. Similarly, AUC values for the MELD score > 20 were 0.877; (95% CI: 0.854-0.900), 0.935; (95% CI: 0.918-0.952), and 0.861; (95% CI: 0.835-0.887); (p < 0.001 for all).

CONCLUSIONS

Tp-e, Tp-e/QT, and Tp-e/QTc values were significantly higher in patients with LC. These indexes can be useful for arrhythmia risk stratification and to predict the end-stage of the disease.

Prevalence and Determinants of Gastrointestinal Manifestations in Patients with Selected Rheumatologic Diseases

BACKGROUND

Many rheumatic diseases may cause gastrointestinal manifestations. The goal of this study was to analyze the prevalence and predictors of gastrointestinal involvement in patients with rheumatic disorders.

METHODS

A retrospective chart review was performed for patients with systemic lupus erythematosus, rheumatoid arthritis, and sys- temic sclerosis who have consulted due to gastrointestinal symptoms. The relationship between clinical symptoms, gastroscopic/colo- noscopic findings, and histopathological results with current drugs and disease duration was evaluated.

RESULTS

A total of 364 patients with rheumatic disorders and 740 people as control group were included in the study. Abdominal bloating followed by abdominal pain, regurgitation, and heartburn were reported as the main complaints by more than half of the patients. Most of the patients had gastric mucosal changes expressed as Lanza score, and the presence of major polypharmacy was the most important factor affecting Lanza score (odds ratio: 10, 95% CI: 1.882-54.111, P < .007) followed by disease duration (odds ratio: 1.559, 95% CI: 1.369-1.775, P < .001) and age (odds ratio: 1.069, 95% CI: 1.030-1.109, P < .001). In general, approximately 30% of the patients were posi- tive for Helicobacter pylori infection and 35% showed intestinal metaplasia in histopathological examination. Most of the colonoscopic findings were associated with colonic polyps (n = 81). In multivariate analysis, disease duration was the only factor that affected the pres- ence of colonic lesions (Area Under the Receiver Operating Characteristic (ROC) Curve (AUROC): 0.871, 95% CI: 0.824-0.918, P < .001).

CONCLUSION

Patients with rheumatologic diseases frequently have gastrointestinal manifestations. The most encountered gastrointes- tinal symptom was abdominal bloating, followed by abdominal pain. Being aware of gastrointestinal manifestations and their determi- nants may help physicians manage and follow patients with rheumatologic disorders.

Lymphocyte to Monocyte Ratio and C-Reactive Protein Combination as the Best Simple Predictor of Treatment Response in Cirrhotic Patients with Culture Negative Neutrocytic Ascites

OBJECTIVES

The aim of this study was to evaluate the most ideal inflammatory markers for treatment response and to determine a cutoff value that could predict response to treatment for culture negative neutrocytic ascite (CNNA) patients.

METHODS

This is a retrospective cross-sectional case-controlled study. Patients with CNNA were evaluated by taking ascites fluid sampling at the beginning and on the 5^th day of treatment. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-monocyte ratio were calculated.

RESULTS

Of the 123 cases with cirrhotic ascites disease, 59 were CCNA and 64 were the control group without ascite-fluid infection. There were statistically significant differences for blood monocyte count, NLR (p<0.01), LMR, and C-reactive protein (CRP) (p<0.001) between two groups. Patients in the CNNA group were compared before and after treatment among themselves for the treatment response. There was statistically significant difference in mean platelet volume, monocyte, LMR, and CRP (p<0.05) between two groups. After receiver operator characteristics curve analysis, the best cutoff value for monocyte was <0.64 × 10³/μL (sensitivity 49.2%, specificity 74.6%, positive predictive value [PPV] 65.9%, and negative predictive value [NPV] 59.5%) (p<0.01), for LMR was ≥1.7 (sensitivity 76.3%, specificity 78%, PPV 77.6%, and NPV 76.7%), and for CRP was ≤18 mg/L (sensitivity 91.5% specificity 57.6%, PPV 68.4%, and NPV 87.2%) (p<0.001). When LMR and CRP were used together, sensitivity (86.5%), specificity (83.1%), PPV (83.6%), and NPV (86%) were found to be statistically significantly higher (p<0.001).

CONCLUSION

Our results showed that in cirrhotic patients with CNNA, combined LMR + CRP can be used as a novel, low cost and non-invasive test to predict treatment response.

Clinical, angiographic and procedural characteristics of longitudinal stent deformation

Recently, longitudinal stent deformation (LSD) has been reported increasingly. Even though the reported cases included almost all stent designs, most cases were seen in the Element™ stent design (Boston Scientific, Natick, MA, USA). It is considered that stent design, lesion and procedural characteristics play a role in the etiology of LSD. Yet, the effect of LSD on long-term clinical outcomes has not been studied well. Element stents implanted between January 2013 and April 2015 in our hospital were examined retrospectively. Patients were grouped into two according to the presence of LSD, and their clinical, lesion and procedural characteristics were studied. Twenty-four LSD's were detected in 1812 Element stents deployed in 1314 patients (1.83 % of PCI cases and 1.32 % of all Element stents). LMCA lesions (16.7 % vs 1.6 %, p < 0.001), complex lesions (75 % vs 35.1 %, p < 0.001), bifurcation lesions (37.5 % vs 18.3 %, p = 0.017), ostial lesions (33.3 % vs 12.8 %, p = 0.003), using of extra-support guiding catheter (54.2 % vs 22.3 %, p < 0.001) and extra-support guidewire (37.5 % vs 16.2 %, p = 0.005) were found to be more frequent in cases with LSD than in cases without it. In addition, the number of stents, stent inflation pressure and the use of post-dilatation were significantly different between the two groups. Two patients had an adverse event during the follow-up period. LSD is a rarely encountered complication, and is more common in complex lesions such as ostial, bifurcation and LMCA lesions. The use of extra-support guiding catheter, extra-support guidewires and low stent inflation pressure increases the occurrence of LSD. Nevertheless, with increased awareness of LSD and proper treatment, unwanted long-term outcomes can be successfully prevented.

Malignant melanoma of the stomach presenting in a woman: a case report

INTRODUCTION

Malignant melanoma is reported to metastasize to all organs of the human body. Although it is common for it to metastasize to the gastrointestinal tract, a melanoma located primarily in the gastric mucosa is an uncommon tumor. Gastrointestinal metastases are rarely diagnosed before death with radiological and endoscopic techniques.

CASE PRESENTATION

In this case report the clinical course and treatment of a woman with melanoma of the stomach, without any other detectable primary lesion, is presented and discussed. A 55-year-old Turkish woman presented to our clinic with complaints of muscle pain and bone pain in the left side of her chest. During an upper gastrointestinal system endoscopy, dark cherry-colored, light elevated, round-shaped lesions were taken from her gastric fundus and from the first part of her duodenum. Biopsies from these samples were determined to be malignant melanoma by the pathologist.

CONCLUSION

Metastatic malignant melanoma cases should be examined through endoscopy for gastrointestinal metastases.