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Öğe Antiviral Treatment Results and Side Effects During Treatment in Chronic Hepatitis B Patients(Doc Design Informatics Co Ltd, 2021) Bulut, Rukiyye; Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Bitirgen, MehmetObjective: Hepatitis B virus is an important health problem leading to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. This study aimed to compare the efficacy and side effects of antiviral drugs used in chronic hepatitis B (CHB). Methods: Five hundred seventy-two patients who were followed and treated with CHB in our clinic were evaluated retrospectively. Results: Fifty-six point five of 572 patients were male, 43.5% were female, and the mean age of the patients was 43.4 +/- 12.4. Of the patients, 153 (26.8%) used tenofovir disoproxil fumarate (TDF), 134 (23.4%) telbivudine (LdT), 114 (20%) entecavir (ETC), 92 (16%) lamivudine (LAM), 26 (4.5%) adefovir (ADV), 27 (4.7%) pegylated interpheron alpha (PEG-IFN-alpha), and 26 (4.6%) used PEG-IFN-alpha + nucleoside analogue (NA). No significant difference was detected between the treatment groups in terms of age, sex ratio, fibrosis, histological activity index (HAI) score, baseline platelet, international normalized ratio (INR), alpha-fetoprotein (AFP) values (p>0.05). Seventy (12.3%) of 568 patients were HBeAg (+), 498 (87.7%) were HBeAg (-). At the end of the first year, the virological response rates were 92.5% in LdT, 82.6% in LAM, 72.8% in ETV, 60.7% in TDF, 26.9% in ADV, 22.2% in PEG-IFN-alpha, 65.3% in PEG-IFN-alpha+NA groups. Twenty-three point eight of the patients had treatment changes, and 76.3% of these patients preferred TDF as a new treatment. Virological breakthrough was observed at 43.5% in LAM, 13.4% in LdT, 7% in ETV and 0.6% in TDF groups. At the end of 3, 4, and 5 years without treatment change, all patients who continued TDF, ETV, LdT, ADV, and LAM treatment were HBV DNA negative. HBsAg clearance developed in 13 (2.3%) patients. At least one side effect was observed in 169 (29.5%) of all patients, and the group with the most frequent side effects was PEG-IFN-alpha+NA (92.3%) and PEG-IFN-alpha (77.8%). Amylase increase in LAM (%3.2), CPK increase in LdT (%27.6), CPK increase in TDF (%3.2) groups were the most common side effects. Conclusions: The drug with the lowest virological response rate and the most common side effect is PEG-IFN-alpha, so its use should be limited to selected patient groups. Treatments with the lowest incidence of side effects and development of resistance were found to be with TDF and ETV. Considering the high virological response rates, TDF and ETV should be preferred in the treatment of CHB. When all treatments are evaluated, HBsAg loss and cure rates are inadequate.Öğe Association of Tumor Necrosis Factor Alpha -238G/A and -308G/A Promotor Polymorphisms with Clearance of Hepatitis B Virus Infection in Turkish Population(2019) İnkaya, Ahmet Çağkan; Türk Arıbaş, Emel; Erayman, İbrahim; Kandemir, Bahar; Acar, Hasan; Bitirgen, MehmetObjectives: Acute viral hepatitis B may lead to chronic hepatitis in 6% of adultpopulation. We compared the frequency of Tumor necrosis factor alpha promotor polymorphisms in chronic hepatitis B patients and people with natural immunity against hepatitis B.Materials and Methods: Chronic hepatitis B patients and age matched control cases with natural immunity to hepatitis B virus were recruited 1:1 in this study. Tumornecrosis factor alpha -238G/A and -308G/A polymorphisms were studied withPCR-RFLP. ?2 test was performed in statistical analysis.Results: A total of 101 volunteers enrolled in two study groups. Thirty-eight menand 12 women constituted the chronic hepatitis B patient group and 40 men and11 women recruited in natural immunity group. Frequency of -238G allele was87.5% and 97% in chronic hepatitis B and natural immunity groups, respectively.Frequency of -308G allel was 93% and 92.1% in chronic hepatitis B and natural im-munity groups, respectively. Frequencies of polymorphisms at positions -238 and-308 in the promotor of tumor necrosis factor alpha gene were not different be-tween chronic hepatitis B and natural immunity groups.Discussion: Tumor necrosis factor alpha promoter polymorphisms at -238 and-308 positions do not effect the outcome hepatitis B infection in Turkish population. Clearance of hepatitis B virus infection is multifactorial. Thus, further studiesneeded to identify genetic predisposition to chronic hepatitis B infection.Öğe Crimean-Congo Haemorrhagic Fever and the Role of the Migrating Birds(Aves, 2019) Kepenek-Kurt, Esma; Kandemir, Bahar; Erayman, Ibrahim; Bulut, Rukiyye; Bitirgen, MehmetObjective: We aimed to analyse patients with Crimean-Congo haemorrhagic fever (CCHF) followed in our clinic. Methods: Clinical features, laboratory findings and treatments of 12 patients with CCHF followed between 2009 and 2018 were analysed retrospectively. Results: Mean age of the patients was 37.6 +/- 13.7 (ranges 17-59); 5 (42%) were female and 7 (58%) were male. All had a history of visit to the rural areas. Fever in 10 (83%) and fatigue in 6 (50%) patients were the most common symptoms. 11 (92%) patients were from Konya and its surroundings, and 1 (8%) from Gumushane, endemic for CCHE Tick exposure was detected in 10 (83%) cases. Diagnosis was made by CCHF virus (CCHFV) RNA positivity by polymerase chain reaction (PCR) in 10 patients, while anti-CCHFV IgM antibodies by enzyme-linked immunosorbent assay were positive in two PCR-negative patients. Four patients received blood and blood products for bleeding and five patients received oral ribavirin. Eleven patients were cured and one died. There was not any nosocomial transmission in our hospital. Conclusions: In prevention of CCHE personal protection and prevention from the tick bites should be ensured. Training about transmission routes and prevention methods of CCHF should be provided to health care personnel and persons especially living in rural areas. Because Beysehir Lake which lies in the Beysehir province of Konya, is on the migration routes of migratory birds, it should be considered that inhabitants living in the region are at risk for CCHE CCHF should be considered in the differential diagnosis of patients with fever, fatigue, thrombocytopenia and elevated liver enzymes.Öğe Evaluation of Patients Infected with Human Immunodeficiency Virus Followed in Our Clinic(Bilimsel Tip Yayinevi, 2020) Kurt, Esma Kepenek; Kandemir, Bahar; Erayman, Ibrahim; Bulut, Rukiyye; Bitirgen, MehmetIntroduction: The number of people infected with human immunodeficiency virus (HIV) in our country is increasing day by day. In this study, epidemiological, clinical, laboratory features, treatment regimens and side effects of HIV/AIDS cases followed in our clinic were evaluated. Materials and Methods: Fifty-four patients who were followed up with HIV infection in our clinic between 2000-2018 were examined retrospectively. Results: Of the 54 patients, 18 (33.3%) were females and 36 (66.7%) were males. Mean age was 42.0 +/- 15.2 (18-70) years. Mean duration of the disease was median 3 (0.5-28) and the duration of clinical follow-up was 3.3 +/- 2.7 (0.5-10) years. A total of 44 (88%) patients had risky sexual contact, and nine women were infected by her husband. The first complaint of the patients for admission to our clinic was weakness (22.2%) and fever (9.3%). Patients were diagnosed most frequently during routine examinations (48%). Mean CD4 count of the patients at the time of admission was 317.2 +/- 247.7 (7-918) cell/mm(3), and HIV-RNA was median 61000 (0-30000000) copy/mL. The most frequent treatment was tenofovir disoproxil fumarate-emtricitabine and lopinavir/ritonavir (TDF-FTC and LPV/r) in 24.4% of the patients. Treatment was changed in 14 (25.9%) patients. In five patients, noncompliance to treatment and in five patients, side effects were encountered, and treatment was changed. Hyperlipidemia was the most common side effect (52.9%) in patients receiving treatment. Prophylaxis was given to 50% of the patients in terms of opportunistic infections at the beginning of treatment. One patient had gonococcal urethritis and one patient had HPV infection in the cervix. Four patients discontinued treatment and 46 patients continued treatment. One female patient was exitus. Conclusion: The number of HIV/AIDS patients, a chronic disease, is increasing also in our country. Early diagnosis of these patients should be made, and the disease should be controlled by providing access to treatment and suppression of viral load.Öğe GPER-1 in chronic hepatitis B(Elsevier, 2020) Kandemir, Bahar; Ates, Selma; Kurutas, Ergul Belge; Durduran, Yasemin; Erayman, Ibrahim; Bitirgen, MehmetEstrogen has a significant role in regulating cell proliferation, growth, migration, aging, and many disease states. Estrogen shows its effects through estrogen receptors alpha, beta, and G protein-coupled estrogen receptor 1 (GPER1). The aim of this study is to evaluate serum GPER1 levels and its relationship with fibrosis score in chronic hepatitis B patients. The cases were selected from two university hospitals and consisted of patients who had not previously been treated for hepatitis B, were over 18. Quantitative sandwich enzyme immunoassay technique was used for measuring the serum levels of GPER1. The data evaluated were analyzed by using the statistical tests. Out of the 65 cases; 26 (40%) had hepatitis B, 39 (60%) were controls. Patients underwent liver biopsy. GPER1 levels were significantly high in Hepatitis B group (p < 0.001). Out of the 26 hepatitis B patients; 21(80,8%) had low-stage fibrosis, 5(19,2%) had high-stage fibrosis. When the GPER1 level was >= 017600000 the sensitivity, specificity, positive predictive value, and negative predictive value for the hepatitis B patients were found to be 96%, 87,7%, 96%, and 92,8%, respectively. GPER levels have shown high expression in patients with chronic hepatitis B.Öğe Investigating Hepatitis C, D and HIV Prevalance in Cases with Positive Hepatitis B Virus Antigen in a Tertiary Hospital and Examining Anti-HDV Positive Cases(Galenos Publ House, 2021) Kurt, Esma Kepenek; Bulut, Rukiyye; Kandemir, Bahar; Erayman, Ibrahim; Bitirgen, Mehmet; Tasbent, Fatma EsenkayaObjectives: Hepatitis B infection has a faster and more progressive course in the presence of hepatitis C virus (HCV), HDV and human immunodeficiency virus (HIV) infections. The aim of this study was to determine anti-HCV, anti-HDV and anti-HIV prevalance in hepatitis B surface antigen (HBsAg) (+) positive patients and to examine patients with positive anti-HDV. Materials and Methods: Data were obtained through scanning hepatitisB patient follow-up files and the hospital automation system. Descriptive data was expressed in numbers and percentages (%). Results: Mean age of 1829 HBsAg positive patients was 42.65 +/- 14.83 (7-95) and 1099 (60.1%) were male and 730 (39.9%) were female. 30 patients (1.64%) had anti-HCV and 28 patients (1.53%) had anti-HDV while 1 patient (0.055%) had positive anti-HIV. The mean age of the patients with positive anti-HDV was 53.16 +/- 15.46 and 12 of these (42.9%) were female and 16 (57.1%) were male. Fifteen HDV positive patients were given peginterferon and 10 patients had relapse and 4 patients had hepatocellular cancer during the follow-up. A patient died due to the quick progression of the disease after deciding upon transplantation. Conclusion: Patients should also be scanned for hepatitis C, D and HIV in the presence of hepatitis B infection and the patient should be followed up and treated accordingly if coinfection is detected.Öğe Role of Neopterin in Determining the Efficacy of Interferon Therapy in Chronic Hepatitis B and C(Modestum Ltd, 2015) Ozcimen, Serap; Bitirgen, Mehmet; Kandemir, BaharNeopterin (NP) is a pteridine derivative that is secreted as a response to gamma interferon stimulation. The purpose in this study was to investigate the relationship between the NP levels and the disease and determining the efficacy of an interferon (IFN) therapy in patients with chronic hepatitis B (CHB) and C (CHC). The study was conducted on 49 cases with CHB, 30 cases with CHC and 72 healthy individuals. Serum samples were taken from the patients receiving treatment at the beginning and at the end of the treatment and only once from the healthy individuals in the control group. The NP levels were found significantly higher in the patients with CHB and CHC than those in the control group. When the pre and post-treatment serum NP levels of the patients who received an interferon therapy were compared, the post-treatment NP levels of the patients who responded to the treatment were significantly higher. When a comparison was made before and after treatment, a decrease was seen in the NP levels in most of the infections due to decreased activation of the immune system. However, when the disease was treated with an IFN therapy, which is a treatment stimulating the immune system, the post-treatment NP level remained high.Öğe Role of Neopterin in Determining the Efficacy of Interferon Therapy in Chronic Hepatitis B and C(Modestum Ltd, 2015) Ozcimen, Serap; Bitirgen, Mehmet; Kandemir, BaharNeopterin (NP) is a pteridine derivative that is secreted as a response to gamma interferon stimulation. The purpose in this study was to investigate the relationship between the NP levels and the disease and determining the efficacy of an interferon (IFN) therapy in patients with chronic hepatitis B (CHB) and C (CHC). The study was conducted on 49 cases with CHB, 30 cases with CHC and 72 healthy individuals. Serum samples were taken from the patients receiving treatment at the beginning and at the end of the treatment and only once from the healthy individuals in the control group. The NP levels were found significantly higher in the patients with CHB and CHC than those in the control group. When the pre and post-treatment serum NP levels of the patients who received an interferon therapy were compared, the post-treatment NP levels of the patients who responded to the treatment were significantly higher. When a comparison was made before and after treatment, a decrease was seen in the NP levels in most of the infections due to decreased activation of the immune system. However, when the disease was treated with an IFN therapy, which is a treatment stimulating the immune system, the post-treatment NP level remained high.
