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Öğe Association Between the Severity of Nocturnal Hypoxia in Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Damage(KOWSAR PUBL, 2015) Cakmak, Erol; Duksal, Faysal; Altinkaya, Engin; Acibucu, Fettah; Dogan, Omer Tamer; Yonem, Ozlem; Yilmaz, AbdulkerimBackground: Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis. Objectives: This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia. Patients and Methods: In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of <5, 5 -14, 15 - 29 and = 30 are categorized as control, mild, moderate and severe, respectively. Results: One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 +/- 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO(2) values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O-2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner. Conclusions: We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO(2) levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.Öğe Association of Nonalcoholic Fatty Liver Damage and the Degree of Nocturnal Hypoxia in Obstructive Sleep Apnea(WILEY-BLACKWELL, 2015) Cakmak, Erol; Duksal, Faysal; Altinkaya, Engin; Acibucu, Fettah; Dogan, Omer T.; Yonem, Ozlem; Yilmaz, Abdulkerim…Öğe DİREKT ETKİLİ ANTİVİRAL TEDAVİ ALAN KRONİK HEPATİT C HASTALARINDA ALFA FETOPROTEİN SONUÇLARININ DEĞERLENDİRİLMESİ(2021) Aktaş, Ahmet; Altinkaya, EnginAmaç: Kronik hepatit C tanılı hastalarda doğrudan etkiliantiviral ilaç tedavisi sonrasında nekroinflamasyonun birgöstergesi olan alfa fetoprotein değerinde meydana gelendeğişimi saptamaktır.Gereç ve Yöntemler: Çalışmamızda Ocak 2015 ile Ocak2020 tarihleri arasında Cumhuriyet Üniversitesi Tıp FakültesiGastroenteroloji Bilim Dalı Polikliniğinde değerlendirilipkronik hepatit C tanısı ile direkt etkili antiviral tedavibaşlanan 294 hastanın verileri retrospektif olarakincelenmiştir. Aldıkları direkt etkili antiviral tedavilerinegöre; sofosbuvir/Ledipasvir ± ribavirin tedavisi alan hastalar1. grup (n=114), paritaprevir + ritonavir/ombitasvir ±dasabuvir ± ribavirin tedavisi alan hastalar 2. grup (n=180)olarak iki ana grupta değerlendirilmiştir.Bulgular: Hastaların tedavi öncesindeki ortalama alfafetoprotein değeri 8.25±10.82 ng/ml, tedavi bitimindekiortalama alfa fetoprotein değeri ise 5.14±10.80 ng/ml olaraksaptanmış ve bu değişim istatistiksel olarak anlamlıbulunmuştur (p<0.01). Birinci grupta tedavi bitimindeki alfafetoprotein değerinde tedavi öncesi değere göre anlamlıdüşme gözlenirken (p<0.01), 2. grupta hafif düşmegözlenmiş; ancak bu düşüş istatistiksel olarak anlamlıbulunmamıştır (p=0.175).Sonuç: Çalışmamızda kronik hepatit C tanılı hastalardagüncel antiviral tedaviler ile nekroinflamasyonun birgöstergesi olan alfa fetoprotein değerlerinde gerileme olduğusaptanmış ve direkt etkili antiviral ile tedavi sonrası erkendönemde fibroziste anlamlı iyileşme olduğu görülmüştür.Öğe 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, AhmetPurpose: 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.Öğe Endoscopic Ultrasound-Guided Fine Needle Aspiration Using a 22-G Needle for Hepatic Lesions: Single-Center Experience(Korean Soc Gastrointestinal Endoscopy, 2021) Akay, Ebru; Atasoy, Deniz; Altinkaya, Engin; Koc, Ali; Ertan, Tamer; Karaman, Hatice; Caglar, ErkanBackground/Aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been accepted as a reliable tool in diagnosing and staging intra-abdominal tumors. In this study, we aimed to investigate the performance of EUS-FNA in the evaluation of liver masses and its impact on patient management and procedure-related complications retrospectively. Methods: Data of patients who underwent EUS-FNA biopsies due to liver masses between November 2017 and July 2018 were retrieved retrospectively. Biopsies were performed using 22-G needles. The demographics, EUS-FNA results, sensitivity and specificity of the procedure, negative predictive value, positive predictive value, and specimen sufficiency rates were assessed. Results: A total of 25 patients (10 females) were included in the study. The mean age was 62.73 +/- 15.2 years. The mean size of the masses was 34.50 +/- 16.04 mm. The technical success rate was 88%. During the EUS-FNA procedure, each patient had only one pass with 94.45% of aspirate sufficiency rate and 86.3% of biopsy sufficiency rate. The diagnostic accuracy rate was 86.3%. There were no complications. Conclusions: For the evaluation of liver masses, EUS-FNA using a 22-G needle with even one pass had high aspiration and biopsy success rates accompanied with high diagnostic accuracy rates.Öğe Evaluation of Alpha Fetoprotein Results in Chronic Hepatitis C Patients Who Received Directly Acting Antivral Treatment(Kırıkkale Üniversitesi, 2021) Aktaş, Ahmet; Altinkaya, EnginObjective: It is to detect a change in the value of alpha fetoprotein, which is an indicator of necroinflammation after direct effective antiviral drug therapy in patients diagnosed with chronic hepatitis C.Material and Methods: In our study, the data of 294 patients who were evaluated in the Gastroenterology outpatient clinic of Cumhuriyet University Faculty of Medicine between January 2015 and January 2020, and who were diagnosed with chronic hepatitis C and started direct-acting antiviral treatment, were retrospectively analyzed. Patients were evaluated in 2 main groups according to the direct acting antiviral treatments they received. Patients who received sofosbuvir + ledipasvir ± Ribavirin treatment were the first group (n=114) and the patients who received paritaprevir + ritonavir/ Ombitasvir ± Dasabuvir ± Ribavirin treatment were the second group (n=180).Results: The mean alpha fetoprotein value of the patients before treatment was 8.25±10.82 ng/ml and the mean alpha fetoprotein value at the end of the treatment was 5.14±10.80 ng/ml and this change was statistically significant (p<0.01). In the first group, alpha fetoprotein values at the end of treatment decreased significantly compared to the pretreatment value (p<0.01), whereas in the second group a slight decrease was observed. However, this decrease was not statistically significant (p=0.175).Conclusion: In our study, it was determined that alpha-fetoprotein values, which is an indicator of necroinflammation, decreased with current antiviral treatments in patients with chronic hepatitis C, and a significant improvement in fibrosis was observed in the early period after treatment with direct-acting antiviral.Öğe Evaluation of platelet-to-lymphocyte ratio, red cell distribution width and neutrophil-to-lymphocyte ratio as potential biomarkers in the early detection of gastric cancer(E-CENTURY PUBLISHING CORP, 2016) Cakmak, Erol; Altinkaya, Engin; Acibucu, Fettah; Yonem, Ozlem; Yilmaz, AbdulkerimGastric cancer is the third highest malignity for cancer-related mortality worldwide. Reduction of morbidity and mortality requires early recognition and management of gastric cancer. In recent years, biomarkers reflecting the systemic inflammatory state have been used for both diagnostic and prognostic testing. Our objective was to determine whether global inflammatory markers such as platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), and neutrophil-to-lymphocyte ratio (NLR) have clinical utility in the early diagnosis of gastric cancer. We included 53 individuals diagnosed as stomach cancer, and 53 healthy age-and sex-matched subjects. Preoperative clinical and pathological data as well as information on hemoglobin levels, neutrophil, lymphocyte and platelet counts were derived from the medical records of patients. A receiver-operating characteristic (ROC) curve was calculated to identify potential criteria for using these biomarkers in the diagnosis of gastric cancer. In patients with gastric cancer, PLR, RDW, and NLR were significantly elevated when compared to healthy control subjects (P < 0.001). The optimal diagnostic cut-off was 2.17 in the ROC curve analysis [area under the curve (AUC): 0.750, sensitivity: 73%, specificity: 61%] for NLR, 128 (AUC: 0.747, sensitivity: 72%, specificity: 64%) for PLR, and 14 (AUC: 0.768, sensitivity: 70%, specificity: 74%) for RDW. The present study suggests that NLR, PLR and RDW, which are easily obtained from a routine complete blood count may be useful as potential, biomarkers for determination of early diagnosis and prognosis of gastric cancerÖğe HEPATITIS B REACTIVATION RISK IN PATIENTS WITH RHEUMATOLOGIC DISEASES UNDER BIOLOGIC TREATMENT(Carbone Editore, 2021) Gokcen, Pinar; Altinkaya, EnginIntroduction: Hepatitis B virus reactivation (HBVr) is a clinical entity that can occur due to the use of immunosuppressive medications and causes serious complications that can threaten survival. In this study, we aimed to investigate the effects of the biological agents used in rheumatology on HBVr in a large patient population. Materials and methods: Patients with rheumatologic diseases who were on biological treatment were analyzed according to hepatitis B virus (HBV) serology. Patients with resolved HBV and inactive chronic HBV were included in the study. Prophylaxis status, HBVr and hepatic flare were recorded. Results: 749 patients were screened by medical records. 106 (14.2%) patients were in the resolved HBV group and 15 (2%) patients were inactive HBV carrier. Prophylaxis was not administered to 74 (69.8 %) patients in the resolved HBV group and 4 (26.7%) patients in the inactive chronic HBV group. None of the patients demonstrated HBVr. Conclusion: We suggest that long-term prophylactic oral antiviral treatment can be avoided by the close follow-up of patients who were on tumour necrosis factor a (TNF a) or cytokine inhibitors due to low HBVr risk. On the other hand, patients receiving rituximab must be more carefully evaluated to prevent patients from not receiving antiviral prophylaxis.Öğe Insulin and Heparin Therapies in Acute Pancreatitis due to Hypertriglyceridemia(Coll Physicians & Surgeons Pakistan, 2021) Altinkaya, Engin; Aktas, AhmetObjective: 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.Öğe İnsülin direncinin akut pankreatit şiddetine etkisi(2022) Keskin, Enes; Altinkaya, EnginGiriş ve Amaç: Akut pankreatit, pankreasın çeşitli nedenlere bağlı inflamasyonudur. Tüm dünyada önemli bir morbidite ve mortalite nedenidir. Metabolik sendromun önemli bir komponenti olan insülin direncinin inflamatuvar bir durum olması nedeniyle akut pankreatit hastalarında hastalık şiddetini etkileyebileceği düşünülmektedir. Çalışmamızda insülin direncinin akut pankreatit şiddeti ile ilişkisini araştırmayı ve diğer prognostik faktörlerle karşılaştırmayı amaçladık. Gereç ve Yöntem: Çalışmamızda klinikte akut pankreatit tanısı ile yatarak tedavi almış 84 hasta değerlendirmeye alınmıştır. Çalışmamız prospektif olarak dizayn edilmiştir. Akut pankreatit şiddetini belirlemek için hastaların laboratuvar ve görüntüleme bulguları kullanılarak Atlanta Sınıflandırması, 'Bedside Index of Severity in Acute Pancreatitis' skoru, Imrie skoru, Ranson skoru, Balthazar skoru belirlenmiştir. Hastalarda insülin direnci değerlendirilmesi için “İnsülin Direncinin Homeostatik Modeli Değerlendirmesi” skoru kullanılmıştır. Buna göre insülin direnci olan ve olmayan gruplar arasında hastalık şiddeti açısından fark olup olmadığı araştırılmıştır. Bulgular: Hastaların %45.2’si insülin direnci olan grupta yer aldı. Atlanta sınıflandırmasına göre 6 hasta (%7.1) şiddetli akut pankreatit olarak sınıflandırıldı. 4 hasta prerenal akut böbrek hasarı gelişmesi ve 2 hasta sepsis ve yoğun bakım gereksinimi olması nedeniyle şiddetli akut pankreatit olarak değerlendirildi. Hastalık şiddeti açısından yapılan Receiver Operating Characteristic analizinde Balthazar ve “Yatak başı akut pankreatit şiddet indeksi” skorunun hastaların prognozunu belirlemede güçlü oldukları görüldü (sırasıyla eğri altındaki alan; 0.955 ve 0.979). İnsülin direnci olan grubun “Yatak başı akut pankreatit şiddet indeksi” ve Balthazar skorları, insülin direnci olmayan grup ile karşılaştırıldığında istatistiksel olarak anlamlı farklılık saptandı (sırasıyla p = 0.019 ve p = 0.013). Sonuç: Çalışmamızda insülin direnci olan akut pankreatit hastalarında “Yatak başı akut pankreatit şiddet indeksi” ve Balthazar skorlarının yüksek saptanması, insülin direnci varlığının akut pankreatitin şiddetli seyretmesi yönünde prognostik bir faktör olarak kullanılabileceğini düşündürmektedir.Öğe A Misleading Parameter in the Diagnosis of Chronic Hepatitis B: Persistently Normal Transaminases(GALENOS YAYINCILIK, 2018) Ozdogan, Osman; Yaras, Serkan; Koksal, Ali Riza; Altinkaya, Engin; Bayram, Mehmet; Yilmaz Ozguven, Banu; Alkim, CananObjectives: Most of the patients with hepatitis B e (HBe)-negative hepatitis B have persistently normal transaminases (PNALT) levels. Patients, who have higher fibrosis and necroinflammatory activity scores, are at high risk for hepatocellular carcinoma and cirrhosis. Therefore, it is important to distinguish between active and inactive hepatitis in this group. Materials and Methods: Sixty-six treatment-naive, non-cirrotic, HBe antigen (HBeAg)-negative and a PNALT and a level of a hepatitis B virus (HBV) DNA level of >= 2000 IU/mL were included in this study. lshak's scoring system was used for histopathological evaluation. Chronic hepatitis was defined as a fibrosis score of higher than/equal to 2 and/or a histological activity index score of higher than 4. Results: The percentage of patients diagnosed with advanced fibrosis score and high necroinflammatory activity was 65% and 48%, respectively. Accordingly, 76% of patients were considered to have chronic hepatitis. Level of the HBV DNA was the most significant value for predicting chronic hepatitis. 94.1% of patients with a HBV DNA value over 20000 IU/mL had chronic hepatitis (p<0.001). Conclusion: As a result of this study, it has been found that the prevalence of chronic hepatitis in our country was high in HBeAg-negative patients with PNALT and a HBV DNA level higher than 2000 IU/mL. We recommend starting treatment in patients with a HBV DNA level higher than 20000 IU/rnL without considering any other criteria. Close monitoring or biopsy is recommended in patients with HBV DNA values between 2000 and 20000 IU/mL.Öğe The role of proinflammatory cytokines on liver damage after pentylenetetrazole-induced acute and chronic epilepsy models in rats(Sivas Cumhuriyet University, 2021) Altinkaya, Engin; Ataseven, HilmiAbstract Objectives: The mechanisms of acute liver failure resulting from epilepsy are poorly defined and appear to be multifactorial, including hypoxia and steatosis. The role of inflammation on liver damage after seizures is unclear. This study aimed to investigate the relationship between proinflammatory cytokines and liver damage after pentylenetetrazole-induced acute and chronic epilepsy models in rats. Materials and methods: Male Wistar albino adult rats (n = 18), weighing 220–240 g, were used in the experiment. The animals were divided into three groups: (1) Control Group (Control; n = 6); rats were treated with a single dose of saline intraperitoneally (i.p.), (2) Acute Epileptic Model Group (n = 6); rats were treated with a single dose of i.p. PTZ (45 mg/kg), (3) Chronic Epileptic Model Group (n = 6); rats were treated with repeated doses of i.p. PTZ (35 mg/kg) every other day for 15(fifteen) times. Result: There was a significant difference between the control and acute epileptic model in terms of serum AST, TNF-α, IL-1 β and IL-6 parameters (p<0.05). On the other hand, there was a significant difference between the acute and chronic epileptic models in the serum AST, TNF-α and IL-6 parameters (p<0.05). Conclusions: As a result, while liver damage is secondary to hypoxia during epileptic seizures, multifactorial causes are blamed. Proinflammatory cytokines that increase in the liver after these factors may be responsible for liver damage in acute epileptic seizures. Compensation mechanisms such as antioxidant defence mechanism in chronic epileptic seizures may prevent liver damage.
