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    Efficacy of oral combination antiviral therapy in genotype 4 hepatitis C infection and the importance of rapid virological response
    (Pharmacotherapy Group, 2022) Altinkaya, Engin; Aktas, Ahmet
    Purpose: To evaluate the efficacy and safety of ombitasvir (OMV), paritaprevir (PTV), ritonavir (r), ribavirin (RBV) (OMV/PTVr + RBV), ledipasvir (LDV) and sofosbuvir (SOF) therapies in genotype 4 (GT4) patients, and to determine if the rapid virological response (RVR) observed at 4th week of therapy has a role in predicting sustainability of the response at week 12 (SVR12) post-therapy. Methods: The investigation included 71 subjects with diagnosis of Hepatitis C (HCV) GT4. Some of the patients (40/71) were treated using combination of OMV (25 mg/day), PTV (150 mg/day), ritonavir (r) (100 mg/day), while the others (31/71) were treated using combination of LDV (90 mg/day) and SOF (400 mg/day). Body weight-based RBV was added to both treatment regimens, and the treatments given for a total of 84 days. Viral levels in the patients were evaluated after the 4th and 12th week of drug administration, and at 12 weeks post-administration. Results: The SVR12 responses of the patients on the basis of sub-groups, were 97.5 % for OMV/PTVr + RBV, 96.8 % for LDV/SOF + RBV (p = 0.6); 91.3 % for cirrhotic, 100 % for non-cirrhotic (p = 0.1); 100 % in untreated, and 95.5 % for treated (p = 0.33). While there were numerical differences, these were not statistically significant. The SVR12 response was 100 % in patients with RVR response, and 87.5 % for patients without RVR response (p < 0.05). When the patients' aspartate transaminase (AST), alanine transaminase (ALT), platelet (PLT), albumin, creatinine, prothrombin time (PT) and fib4 values before and after treatment were compared, significant difference were observed for all variables (p < 0.01), except for PT (p = 0.3). there were no dangerous adverse events such as decompensation or death, aside from mild fatigue, with incidence of 19 %. Conclusion: RVR response after OMV/PTVr + RBV and LDV/SOF + RBV treatments show that the treatments can be used safely and effectively in patients with HCV genotype 4. Moreover, RVR might be a suitable determinant of SVR12 response.
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    Initial serum lactate levels of COVID-19 patients
    (Bayrakol Medical Publisher, 2021) Yolcu, Sadiye; Sener, Kemal; Yilmaz, Nurettin; Tunc, Mehmet; Aktas, Ahmet; Dogan, Nurettin O.
    Aim: In this study, we aimed to research whether the serum lactate of the COVID-19 patients presented to the initial emergency department can be used to make prognosis of the patients. Materials and Methods: A total of 39 COVID-19 patients were included in the study. Fourteen (35.8%) patients were over 65 years old (Group 1). Twenty-five patients (64.2%) were under 65 years old (Group 2). The diagnosis was made via the oro-nasopharyngeal swab PCR test. We noted the demographic data (age, gender, comorbidities), initial (emergency service presentation) complete blood count parameters including WBC, Plt/Lymp ratio, CRP, procalcitonin and serum lactate levels. We also noted the hospitalization unit (clinic/intensive care unit), hospitalization length, and the outcomes. Patients were divided into two groups according to 65 years and the groups' laboratory results with the prognosis. Results: The mean age of the study group was 55 years. Fourteen (35.8%) patients were over 65 years old. Serum lactate levels did not significantly differ between groups. Hospital length of stay was significantly longer in patients over 65 years of age. Age and hospitalization length were positively correlated with age in all patients. Discussion: Serum lactate level measurement has recently become an important parameter especially for critically ill patients. It is beneficial for predicting the severity and prognosis in severe infections. Serum lactate levels in COVID-19 patients did not differ between age groups. Hospitalization length was longer in elderly patients.
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    Insulin and Heparin Therapies in Acute Pancreatitis due to Hypertriglyceridemia
    (Coll Physicians & Surgeons Pakistan, 2021) Altinkaya, Engin; Aktas, Ahmet
    Objective: To compare insulin infusion and heparin infusion, used to treat hypertriglyceridemia-induced acute pancreatitis in terms of efficacy. Study Design: Descriptive study. Place and Duration of Study: Department of Gastroenterology, Division of Internal Disease, Sivas Cumhuriyet University Hospital, Sivas, Turkey, from 1st January 2013 to 1st January 2020. Methodology: Patients who presented with abdominal pain and were found to have edematous pancreatitis on computed tomography imaging were retrospectively reviewed. Thirty-six patients with hypertriglyceridemia were included. Eighteen of the patients were given insulin infusion, while the other 18 were given heparin infusion therapy. The patients' gender, age, admission amylase values, AST, ALT, total cholesterol, glucose, lactate dehydrogenase (LDH), CRP, leukocyte, pre-treatment and post-treatment first, second, and third-day triglyceride levels were recorded from the files. Results: The post-treatment third-day triglyceride levels of the insulin therapy group were statistically significantly lower compared to the heparin therapy group (432.5; 984, p<0.001, respectively). Conclusion: Insulin infusion, in addition to fluid therapy and electrolyte imbalance, was more effective than heparin therapy in patients with hypertriglyceridemia-induced acute pancreatitis.
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    Investigations of structural, spectral (IR, 1H-, 9F-, 11B-, 13C-, 15 N-, 17O-NMR) and anticancer properties of 5FU@B12N12 complexes
    (Springer International Publishing Ag, 2021) Aktas, Ahmet; Nassif, Wassim; Sayin, Koray
    B12N12 nanocage was selected as a drug carrier for 5-fluorouracil (5FU). Both compounds were optimized B3LYP/6-31 + G(d) level in the water. Electrophilic/nucleophilic attack regions and the appropriate interaction sites were determined by molecular electrostatic potential (MEP) maps. The possible interaction structure between 5FU and B12N12 nanocage was determined. Additionally, it was determined that five pieces of 5FU were coordinated to BN nanocage step by step. Each compound is characterized as structurally. IR, H-1-, F-9-, B-11-, C-13-, (15) N-, O-17-NMR spectra are calculated and compared with published data. The interaction energies and deformation energies were calculated for each BN-5FU complex. As for the biological application, 5FU and B12N12 nanocage were interacted with vascular endothelial growth factor receptor 2 (VEGFR2), which PDB ID is 2OH4. The possible structure of drugs at pH = 7 +/- 1 was determined. Molecular docking analyses of each drug and its possible structures were performed with 2OH4. It was found that studied compounds interacted with 2OH4. This result implies that the studied compounds can be used as an anti-cancer drug.
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    Protective Effect of Melatonin and Mycophenolate Mofetil Against Nephrotoxicity Induced by Tacrolimus in Wistar Rats
    (Kafkas Univ, Veteriner Fakultesi Dergisi, 2022) Koc, Suleyman; Aktas, Ahmet; Sahin, Bilal; Ozkaraca, Mustafa
    Although Tacrolimus (TAC) is a potent and well-tolerated drug, it has some side effects. Melatonin and mycophenolate mofetil (MMF) have some protective properties against drug-induced damage. We aimed to evaluate TAC-induced nephrotoxicity and the protective effect of melatonin and MMF against this injury in rats. The animals were divided into five equal groups (n): Control group (untreated), group II TAC, group III as the TAC + melatonin, group IV as the TAC + MMF, and group V as the TAC + melatonin + MMF. TAC was applied orally, 2 mg/kg once daily. Melatonin and MMF were applied orally 10 mg/kg once and 40 mg/kg once daily, respectively. In the TAC group, kidney tissue malondialdehyde (MDA), total oxidative status (TOS), interleukin-1, and tumor necrosis factor-alpha levels were higher, and catalase and total antioxidant status (TAS) levels were lower. Severe histopathologic changes such as glomerular congestion, intertubular hemorrhage, hyaline formation, degenerative-necrotic tubules epithelium, and mononuclear cell infiltration were seen in the TAC group. There was a clear improvement in the groups in which melatonin and MMF were used together with TAC. It was shown that TAC causes nephrotoxicity through oxidative stress. Melatonin and MMF together or separately protect the kidney against oxidative stress damage caused by TAC.
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    Protective effect of ursodeoxycholic acid and resveratrol against tacrolimus induced hepatotoxicity
    (Taylor & Francis Ltd, 2023) Koc, Suleyman; Aktas, Ahmet; Sahin, Bilal; Ozer, Hatice; Zararsiz, Gozde Erturk
    Tacrolimus (TAC) is a potent and well-tolerated immunosuppressive drug, but serious side effects including nephrotoxicity and hepatotoxicity have been reported. Ursodeoxycholic acid (UDCA) and resveratrol (RSV) exhibit hepatoprotective effects in liver diseases. We investigated the hepatoprotective effect of UDCA and RSV against TAC induced hepatotoxicity. We divided 40 male rats into five equal groups: A) control group, B) TAC group, C) TAC + UDCA group, D) TAC + RSV group, E) TAC + UDCA + RSV group. We administered 0.5 mg/kg TAC once daily, 25 mg/kg UDCA twice daily and 10 mg/kg RSV once daily. The drugs in the experimental groups were given by gavage from the first day of the study and continued for 21 days. Histopathologic and biochemical analyses were performed on day 22. In group B, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), tumor necrosis factor-alpha (TNF), interleukin-1 (IL-1), interleukin-6 (IL-6), total oxidative status (TOS) and malondialdehyde (MDA) levels were higher compared to group A, and catalase (CAT), superoxide dismutase (SOD) levels and total antioxidant status (TAS) were lower compared to group A. Severe cellular swelling, degeneration and focal necrosis were more evident in group B than in groups C-E. Histopathological improvement was observed in groups C-E, where UDCA and RSV were combined, compared to group B. We found that UDCA and RSV, together or separately, protected the liver against oxidative stress damage caused by TAC.