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Are Pattern Recognition Receptors Associated with Hepatocellular Carcinoma?
(Aves, 2021) Dertli, Ramazan; Asil, Mehmet; Biyik, Murat; Karakarcayildiz, Ahmet; Keskin, Muharrem; Kayar, Yusuf; Basdemirci, Muserref
Background: Hepatocellular carcinoma (HCC) is one of the important causes of mortality due to malignancy. Toll-like receptors (TLRs) are very important in liver pathophysiology in terms of their roles in the innate immune system, such as the regulation of inflammation, wound healing, stimulation of adaptive immune responses, promotion of epithelial regeneration, and carcinogenesis. In this study, we planned to examine the role of TLR1 (rs4833095, rs5743551) and nucleotide-binding oligomerization domain (NOD2) (rs2066844, rs2066845, rs2066847) polymorphisms in the development of HCC and their effects on the clinical presentation of HCC patients. Methods: Our study was designed prospectively. Cirrhotic and HCC patients who were followed up in our clinic between January 2015 and September 2018 were included in the study. Sex, age, cirrhosis etiology, Child-Pugh class, and MELD scores were recorded. TLR1 and NOD2 polymorphisms were studied by the PCR method. Results: HCC developed in 88 (31.4%) of the 280 patients who were followed up, either during the recruitment phase of our study or during the follow-up. The mean follow-up time of our patient group was 17.04 +/- 11.72 months, and the mean follow-up time of HCC patients was 12.09 +/- 10.26 months. TLR1 (rs5743551) polymorphism was associated with HCC development (P =.003). TLR1 (rs5743551) and NOD2 (rs2066844) polymorphisms were associated with the development of spontaneous bacterial peritonitis (SBP) in the HCC patient group (P =.013 and P =.021, respectively). Conclusion: We think that increased bacterial translocation in cirrhotic patients may contribute to HCC development by causing chronic inflammation, especially in patients with TLR 1 (rs5743551) polymorphism.
Bariatric surgery may exacerbate hyperbilirubinemia in patients with Gilbert's Syndrome
(2017) Asıl, Mehmet; Bıyık, Murat; Ataseven, Hüseyin; Demir, Ali; Dertli, Ramazan; Polat, Hakkı
Biyopsi İle Tanı Konmuş Non-Alkolik Steatohepatit Hastalarında Noninvaziv Bir Belirteç Olarak Nötrofil Lenfosit Oranının Değerlendirilmesi
(2016) Asıl, Mehmet; Dertli, Ramazan
Amaç: Non-alkolik yağlı karaciğer hastalığı dünya çapında prevalansı artan önemli bir sağlık sorunudur. Nötrofil lenfosit oranı basit kan sayımı ile hesaplanabilecek ucuz bir inflamasyon belirtecidir. Bu çalışmada non-alkolik steatohepatit ve basit karaciğer yağlanması olan hastalarda nötrofil lenfosit oranının araştırılması ve sağlıklı kontrollerle karşılaştırılması amaçlanmıştır. Yöntemler: Karaciğer biyopsisi ile tanı konmuş 15 non-alkolik steatohepatit hastası, abdominal ultrasonografiyle tanı konmuş 65 basit karaciğer steatozu hastası ve 65 sağlıklı kontrol çalışmaya dahil edildi. Hastalara fizik muayene yapılarak antropometrik ölçümler alındı. Rutin laboratuar tetkikleri sırasında bakılan hemogramlar kullanılarak nötrofil lenfosit oranı hesaplandı ve çeşitli klinik ve laboratuar parametrelerle ilişkisi araştırıldı. Bulgular: Ortalama nötrofil lenfosit oranı non-alkolik steatohepatit gurubunda 2,160,49, basit steatoz gurubunda 1,620,43 ve sağlıklı kontrollerde 1,510,31 olarak saptanmış olup üç grup arasındaki fark istatistiksel olarak anlamlıydı (p0,001). İkili karşılaştırmalarda nötrofil lenfosit oranı açısından non-alkolik steatohepatit grubu ile hem basit steatozlar hem de sağlıklı kontroller arasındaki farkın istatistiksel olarak anlamlı olduğu (her ikisi için de p0,001) ancak basit steatoz grubu ile sağlıklı kontroller arasında fark olmadığı (p0,086) saptandı. Nötrofil lenfosit oranı ile abdominal ultrasonografideki yağlanma derecesi ya da karaciğer biyopsi bulguları arasında ilişki saptanmadı (p0,05). Yapılan ROC analizlerinde non-alkolik steatohepatit hastalarını ayırt etmesi açısından nötrofil lenfosit oranı için AUC0,868 (%95 güven aralığı: 0,781-0,956) ve seçilen 1,793 eşik de- ğeri için hesaplanan sensitivite %86,5 ve spesifite %81 olarak bulundu. Sonuç: Bu çalışmada nötrofil lenfosit oranının non-alkolik steatohepatit hastalarında gerek basit karaciğer steatozu olan hastalardan gerekse sağlıklı kontrollerden daha yüksek olduğu ancak basit steatoz gurubuyla sağlıklı kontroller arasında fark olmadığı saptandı. Bu da nötrofil lenfosit oranındaki artışın non-alkolik steatohepatite bağlı hepatik inflamasyon ve eşlik eden düşük düzey bir sistemik inflamasyon nedeniyle olabileceğini akla getirmektedir
Can Hematological Inflammatory Parameters Predict Mortality in Hepatocellular Carcinoma?
(Springer, 2021) Dertli, Ramazan; Asil, Mehmet; Biyik, Murat; Karakarcayildiz, Ahmet; Keskin, Muharrem; Goktepe, Hakan Mevlut; Kayar, Yusuf
Purpose Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Inflammatory and hematological parameters such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) provided useful information especially in the diagnosis, treatment, and follow-up of malignancies. In this study, we planned to demonstrate the efficacy of NLR and PLR levels in the evaluation of the prognosis of patients with HCC in our clinic. Material and Methods This study was planned as a prospective observational cohort study. The study included 105 patients with HCC on the base of cirrhosis. Our study group was classified according to Barcelona Clinic Liver Cancer (BCLC), Okuda staging system, and Milan criteria at the time of admission. Results The mean age of all cases was 60.6 +/- 12.4 years, and 77 (73.3%) of the patients were male. The mean life expectancy of all patients was 7.7 +/- 4.3 months. During 1-year follow-up, 61 (58.1%) HCC patients died. The mean survival of the patients who died was 4.6 +/- 3.0 months. In our study, patients with NLR > 2.7, patients with PLR > 100.29, BCLC advanced stage, and Okuda advanced stage, and patients who did not meet the Milan criteria had shorter survival duration. NLR > 2.7, BCLC advanced stage, and Child C were determined as independent risk factors affecting mortality. Conclusion There was a strong correlation between NLR-PLR levels and mortality. PLR and NLR levels can be used in conjunction with other staging systems to regulate, monitor, and predict the survival of HCC patients.
Can neutrophil-lymphocyte ratio predict mortality in acute non-variceal upper gastrointestinal bleeding?
(Turkish Assoc Trauma Emergency Surgery, 2022) Dertli, Ramazan; Toka, Bilal; Asil, Mehmet; Kayar, Yusuf; Karakarcayildiz, Ahmet; Goktepe, Mevlut Hakan; Biyik, Murat
BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is one of the common gastrointestinal problems and has a high mortality, especially in patients with poor hemodynamics. Therefore, treatment and follow-up should be managed dynamically. Neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are fast workable, cheap, and easy to calculate hematological parameters. We need easily accessible parameters as well as routine classifications such as Rockall score in the treatment and follow-up of NVUGIB patients, whose hemodynamics are unstable and progress with high mortality. In this study, we planned to evaluate NLR and PLR levels in patients with NVUGIB in the treatment follow-up with other scoring systems and their relationship with mortality in these patients. METHODS: Two hundred and forty-nine patients who were admitted to our clinic between January 2015 and January 2017 diagnosed with NVUGIB, and who underwent necessary examinations and follow-ups, were included in the study. The patients' Glasgow Blacthford, Rockall Score, NLR, and PLR levels were calculated at the first admission. RESULTS: One hundred and fifty-six of the patients were male (70.6%) and the mean age of all patients was 64.5 +/- 18.0 years. After follow-up and treatment, 28 (11.2%) patients died due to bleeding. High NLR and tachycardia at the time of admission and high patient age were found to be independent risk factors affecting the long of hospital stay. High Rockall score, high NLR at admission, and hypotension at admission were shown to be independent risk factors affecting mortality. CONCLUSION: Besides the use of various scoring systems in patients with NVUGIB, we think that the use of simple hematological parameters may be appropriate and the use of these hematological parameters may be useful in the management of patients with unstable hemodynamics.
Can neutrophil-lymphocyte ratio predict mortality in acute non-variceal upper gastrointestinal bleeding?
(Turkish Assoc Trauma Emergency Surgery, 2022) Dertli, Ramazan; Toka, Bilal; Asil, Mehmet; Kayar, Yusuf; Karakarcayildiz, Ahmet; Goktepe, Mevlut Hakan; Biyik, Murat
BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is one of the common gastrointestinal problems and has a high mortality, especially in patients with poor hemodynamics. Therefore, treatment and follow-up should be managed dynamically. Neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are fast workable, cheap, and easy to calculate hematological parameters. We need easily accessible parameters as well as routine classifications such as Rockall score in the treatment and follow-up of NVUGIB patients, whose hemodynamics are unstable and progress with high mortality. In this study, we planned to evaluate NLR and PLR levels in patients with NVUGIB in the treatment follow-up with other scoring systems and their relationship with mortality in these patients. METHODS: Two hundred and forty-nine patients who were admitted to our clinic between January 2015 and January 2017 diagnosed with NVUGIB, and who underwent necessary examinations and follow-ups, were included in the study. The patients' Glasgow Blacthford, Rockall Score, NLR, and PLR levels were calculated at the first admission. RESULTS: One hundred and fifty-six of the patients were male (70.6%) and the mean age of all patients was 64.5 +/- 18.0 years. After follow-up and treatment, 28 (11.2%) patients died due to bleeding. High NLR and tachycardia at the time of admission and high patient age were found to be independent risk factors affecting the long of hospital stay. High Rockall score, high NLR at admission, and hypotension at admission were shown to be independent risk factors affecting mortality. CONCLUSION: Besides the use of various scoring systems in patients with NVUGIB, we think that the use of simple hematological parameters may be appropriate and the use of these hematological parameters may be useful in the management of patients with unstable hemodynamics.
Duodenal varices diagnosed by endoscopic ultrasound: A case report
(2017) Asıl, Mehmet; Dertli, Ramazan; Bıyık, Murat; Ataseven, Hüseyin; Polat, Hakkı; Demir, Ali
Portal hypertension and associated complications cause significant morbidity and mortality in cirrhotic patients. Variceal development is the most important portal hypertension related complication. Varices most commonly occur around the gastroesophageal junction, but ectopic varices may develop in many gastrointestinal and extra-gastrointestinal localizations. Duodenum is one of the most common localizations for ectopic varices. Diagnosis of duodenal varices is usually made by upper gastrointestinal endoscopy, but endoscopic appearance is not diagnostic and usually further investigations are required in order to make accurate diagnosis. Endoscopic ultrasound is the gold standard method for the examination of gastrointestinal submucosal lesions therefore it is alsouseful in the work up of suspected duodenal varices. Here we present a patient with cryptogenic liver cirrhosis followed in our clinic, whom duodenal lesions suspected of duodenal varices were noticed during upper gastrointestinal endoscopic examination and endoscopic ultrasound was used to confirm the presence of duodenal varices.
Dynamic thiol-disulfide homeostasis is disturbed in hepatitis B virus-related chronic hepatitis and liver cirrhosis
(2018) Dertli, Ramazan; Keskin, Muharrem; Bıyık, Murat; Ataseven, Hüseyin; Polat, Hakkı; Demir, Ali; Oltulu, Pembe; Asıl, Mehmet
Background/aim: Thiol-disulfide homeostasis is an important antioxidant defense mechanism. This study was conducted to investigatedynamic thiol-disulfide homeostasis in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis.Materials and methods: Seventy-one treatment-naive patients with chronic hepatitis B (CHB), 50 patients with hepatitis B virusassociated liver cirrhosis, and 45 healthy controls were included in the study. Serum total and native thiol concentrations and serumdisulfide concentrations were measured using an automated method.Results: Mean serum total thiol concentrations in the control, CHB, and cirrhosis groups were 481.64 37.87 µmol/L, 438.50 71.35µmol/L, and 358.07 80.47 µmol/L, respectively (P 0.001), and mean serum native thiol concentrations in the control, CHB, andcirrhosis groups were 452.92 36.43 µmol/L, 400.16 65.92 µmol/L, and 328.15 74.91 µmol/L, respectively (P 0.001). Mean serumdisulfide concentrations in the control, CHB, and cirrhosis groups were 14.38 3.38 µmol/L, 19.19 6.16 µmol/L, and 14.98 5.53µmol/L, respectively (P 0.001). There was a progressive decrease in both mean serum native and total thiol concentrations parallel tothe liver fibrosis stage.Conclusion: : Thiol-disulfide homeostasis is disturbed in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis.
Dynamic thiol-disulfide homeostasis is disturbed in patients with non-alcoholic fatty liver disease
(Walter De Gruyter Gmbh, 2018) Asil, Mehmet; Dertli, Ramazan; Biyik, Murat; Yolacan, Ramazan; Erel, Ozcan; Neselioglu, Salim; Ataseven, Huseyin
Background: Oxidative stress has been implicated in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Plasma thiols are major defense mechanisms against oxidative stress and undergo oxidation to form disulfides under oxidative conditions. This study was conducted to investigate thiol-disulfide homeostasis in NAFLD patients. Methods: Thirty patients with biopsy proven non-alcoholic steatohepatitis (NASH), 40 patients with simple steatosis and 50 healthy controls were included in the study. Serum total and native thiol concentrations and serum disulfide concentration were measured using the Erel and Neselioglu's method. Results: The mean serum total thiol concentrations in the NASH, simple steatosis and control groups were 415 +/- 64 mu mol/L, 447 +/- 38 mu mol/L and 480 +/- 37 mu mol/L, respectively (p < 0.001). The mean serum native thiol concentrations in the NASH, simple steatosis and control groups were 378 +/- 62 mu mol/L, 416 +/- 41 mu mol/L and 451 +/- 36 mu mol/L, respectively (p < 0.001). The mean serum disulfide concentrations in the NASH, simple steatosis and control groups were 18.5 +/- 6.3 mu mol/L, 15.5 +/- 4.8 mu mol/L and 14.9 +/- 3.6 mu mol/L, respectively (p = 0.005). The native thiol/total thiol ratio was significantly lower and the disulfide/total thiol and disulfide/native thiol ratios were significantly higher in the NASH group than in the simple steatosis and control groups. Conclusions: Thiol-disulfide homeostasis is disturbed and shifted toward disulfide side in NAFLD and NASH patients.
Dynamic thiol-disulfide homeostasis is disturbed in patients with non-alcoholic fatty liver disease
(Walter De Gruyter Gmbh, 2018) Asil, Mehmet; Dertli, Ramazan; Biyik, Murat; Yolacan, Ramazan; Erel, Ozcan; Neselioglu, Salim; Ataseven, Huseyin
Background: Oxidative stress has been implicated in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Plasma thiols are major defense mechanisms against oxidative stress and undergo oxidation to form disulfides under oxidative conditions. This study was conducted to investigate thiol-disulfide homeostasis in NAFLD patients. Methods: Thirty patients with biopsy proven non-alcoholic steatohepatitis (NASH), 40 patients with simple steatosis and 50 healthy controls were included in the study. Serum total and native thiol concentrations and serum disulfide concentration were measured using the Erel and Neselioglu's method. Results: The mean serum total thiol concentrations in the NASH, simple steatosis and control groups were 415 +/- 64 mu mol/L, 447 +/- 38 mu mol/L and 480 +/- 37 mu mol/L, respectively (p < 0.001). The mean serum native thiol concentrations in the NASH, simple steatosis and control groups were 378 +/- 62 mu mol/L, 416 +/- 41 mu mol/L and 451 +/- 36 mu mol/L, respectively (p < 0.001). The mean serum disulfide concentrations in the NASH, simple steatosis and control groups were 18.5 +/- 6.3 mu mol/L, 15.5 +/- 4.8 mu mol/L and 14.9 +/- 3.6 mu mol/L, respectively (p = 0.005). The native thiol/total thiol ratio was significantly lower and the disulfide/total thiol and disulfide/native thiol ratios were significantly higher in the NASH group than in the simple steatosis and control groups. Conclusions: Thiol-disulfide homeostasis is disturbed and shifted toward disulfide side in NAFLD and NASH patients.
The effect of low dose ionizing radiation exposure on dynamic thiol-disulfide homeostasis and ischemia modified albumin levels: an observational study
(Elsevier Science Inc, 2020) Arican, Sule; Dertli, Ramazan; Baktik, Suleyman; Hacibeyoglu, Gulcin; Erol, Atilla; Ulukaya, Sinan Oguzhan; Goger, Esra
Background: The primary objective of this study was to investigate the effect of low dose ionizing radiation exposure on thiol/disulfide homeostasis and ischemia modified albumin levels. The secondary objective is to compare thiol/disulfide homeostasis and ischemia modified albumin levels among the personnel exposed to low dose ionizing radiation in anesthesia application areas, in and out of the Operation room. Methods: The study included a total of 90 volunteers aged between 18 and 65 years old, with 45 personnel working in a setting with potential for radiation exposure (Exposed Group) and 45 personnel in a setting without radiation exposure (Control Group). Their native thiol, total thiol, disulphide, albumine and IMA levels were measured. Exposed group included personnel who were exposed to radiation outside the operating room - Operation room (-) Group and inside the Operating room - Operation room (+) Group. Results: Albumin, native and total thiol levels were significantly lower in the participants exposed to radiation in the anesthesia application area, no statistically significant difference was found in terms of disulfide and ischemia modified albumin levels. In the Operation room (-) group exposed to radiation, native thiol and total thiol values were significantly lower compared to the Operation room (+) groups. Conclusion: Awareness of being in danger of oxidative stress should be established in personnel exposed to radiation in the anesthesia application area following low dose ionizing radiation exposure, and the necessary measures should be taken. (C) 2020 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.
Hepatitis B Reactivation in Patients Treated with Direct-Acting Antivirals for Hepatitis C
(Karger, 2022) Toka, Bilal; Koksal, Aydin Seref; Dertli, Ramazan; Sirin, Goktug; Fidan, Sami; Ulger, Yakup; Harmandar, Ferda
Introduction: There is limited research about HBV reactivation (HBVr) due to direct-acting antivirals (DAA) for HCV and most are limited by short duration of follow-up, small sample size, and absence of baseline HBV DNA. We aimed to determine the incidence and clinical course of HBVr in HBsAg and/or anti-HBcIgG positive patients treated with DAA for HCV. Methods: Seven centers retrospectively analyzed their database on HCV patients treated with DAA between 2015 and 2019. Patients with HBV coinfection or resolved HBV infection were enrolled. Serum transaminases, HBsAg, HBeAg, and HBV DNA were followed every 4 weeks during DAA treatment and every 12 weeks 1 year after treatment. Entecavir or tenofovir disoproxil fumarate was started in case of HBVr. The development of HBVr, HBV flare, liver failure, and mortality were determined. Results: 852 patients received DAA treatment for HCV. Among them, 35 (4.1%) had HBV coinfection and 246 (28.9%) had resolved HBV infection. 257 patients (53.3% male, mean age: 63 +/- 9) constituted the study group (29 with coinfection and 228 with resolved infection). Three patients with coinfection were HBV DNA positive. HBVr developed in 10 (34.5%) HBsAg positive patients, either during (n = 3) or 12-48 weeks after finishing DAA treatment. HBV flare and acute liver failure developed in 1 patient (3.4%), each. Two patients with resolved infection developed HBVr (0.87%) and one (0.44%) had HBV flare. Overall, none of the patients died or underwent liver transplantation due to HBVr. Conclusion: Patients with HBV/HCV coinfection have a high risk of HBVr after DAA treatment and should receive antiviral prophylaxis. Patients with resolved infection have a low risk of HBVr and can be monitored by serial ALT measurements.
İatrojenik İntrabdominal Kanama Sonrası Transfüzyon ile İlişkili Akut Akciğer Hasarı: Olgu Sunumu
(2017) Asıl, Mehmet; Dertli, Ramazan; Bıyık, Murat; Ataseven, Hüseyin; Polat, Hakkı; Demir, Ali
Birçok hastanın çeşitli nedenlerle kan transfüzyonuna ihtiyacı olmaktadır. Transfüzyonla ilişkili akut akciğer hasarı (TRALI) hayati risk taşıyabilen önemli bir komplikasyon olup transfüzyonla ilişkili ölümlerin en sık nedenidir. TRALI bir tür akut non-kardiyojenik akciğer ödemi tablosudur. TRALI tanısı Ulusal Kalp-Akciğer ve Kan Enstitüsü Çalışma Gurubu (NHLBI) ya da Kanada Konsensus Toplantısı Kriterleri'ne göre konur. Tanı için akut hipoksi gelişimini gösteren parsiyel arteryel oksijen basıncının, solunan havanın fraksiyonel oksijen konsantrasyonuna oranının 300 mmHg'nın altında olması ya da oda havası solurken oksijen satürasyonunun %90 olması parametreleri ile akciğer grafisinde bilateral infiltrasyon varlığı ve volüm yüklenmesi bulgularının olmaması gereklidir. Burada, tanısal parasentez sonrası iyatrojenik intra-abdominal kanama gelişen ve taze donmuş plazma transfüzyonuna bağlı TRALI ortaya çıkan bir olgu sunulmuştur.
Kronik Hepatit C’de Üçlü Tedavi: Bir Üniversite Hastanesi Gastroenteroloji Kliniğinin Deneyimi
(2016) Polat, Hakkı; Demir, Ali; Ataseven, Hüseyin; Bıyık, Murat; Dertli, Ramazan; Asıl, Mehmet
Amaç: Pegile interferonribavirin kombinasyonu uzun yıllar kronik hepatit C tedavisinde standart tedavi olmuştur. Son yıllarda proteaz inhibitörleri bu kombinasyona ilave edilmiş ve daha yüksek kalıcı virolojik yanıt oranları elde edilebilmiştir. Biz bu çalışmada kliniğimizde takip edilen ve PEG-İFNribavirinproteaz inhibitörü içeren üçlü tedavi alan hastalarımızın verilerini retrospektif olarak değerlendirmeyi amaçladık.Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji Kliniğine Aralık 2012-Aralık 2015 tarihleri arasında başvuran ve proteaz inhibitörü içeren 3'lü tedavi verilen 23 kronik HCV hastasının verileri retrospektif olarak incelenmiştir.Bulgular: Hastaların 18'i (%78,3) kadın ve 5'i (%21,7) erkek ve median yaşları 58 yıl (Aralık 42-70 yıl) idi. Toplam 16 hastada (%69,6) kalıcı virolojik yanıt elde edilmişti. Telaprevir kullanan 18 hastanın 13'ünde (%72,2) ve boseprevir kullanan 5 hastanın 3'ünde (%60) kalıcı virolojik yanıt elde edildi. Daha önce PEG IFNribavirin ikili tedavisi alıp nüks olan 11 hastanın 10'unda (%90,1), kısmi yanıt veren 3 hastanın tamamında ve ilk tedavide primer yanıtsız olan 4 hastanın 2'sinde (%50) kalıcı virolojik yanıt elde edildi. Sirotik olan 9 hastanın 7'si (%77,8) planlanan tedavi süresini tamamladı, 5 hastada (%55,6) kalıcı virolojik yanıt elde edildi. Sirozu olmayan 14 hastanın 12'si (%85,7) tedaviyi tamamlarken, bu hastaların 11'inde (%78,5) kalıcı virolojik yanıt elde edildi. 4 hastada (%17,4) çeşitli yan etkiler nedeniyle tedavi süresi tamamlanamadı.Sonuç: İnterferonsuz tedavi rejimlerinin ülkemizde henüz rutin kullanıma girmediği göz önüne alınırsa, seçilmiş vakalarda PEG IFN, ribavirin ve bir proteaz inhibitörü içeren üçlü tedavilerin hala bir seçenek olabileceği kanaatindeyiz.
May Neutrophil Gelatinase-Associated Lipocalin (NGAL) Level Predict Mortality in Patients with Hepatocellular Carcinoma (HCC)?
(Springer, 2020) Dertli, Ramazan; Biyik, Murat; Yolacan, Ramazan; Karakarcayildiz, Ahmet; Keskin, Muharrem; Kayar, Yusuf; Asil, Mehmet
Purpose Hepatocellular carcinoma (HCC) ranks fifth among the common cancers worldwide. Hepatocarcinogenesis is a multiple-phases process, which involves changes in cellular genomes including high cell proliferation.In this study, we aimed to evaluate the relationship of NGAL level at the time of diagnosis with mortality in patients diagnosed with HCC. Material and Methods A total of 35 patients who developed HCC on the ground of HBV(+) and 30 healthy subjects were included in the study. Barcelona Clinic Liver Cancer (BCLC), Okuda staging system, and Milan criteria were used for staging of the patients with HCC. Results The mean age of all patients was 59.54 +/- 11.57 years. Seventeen (48.6%) HCC patients died during 1-year follow-up. Survival of the patients who met the Milan criteria was longer (log-rank (Mantel-Cox) test, chi 2 = 5.353,p= 0.021). Kaplan-Meier curve was drawn for NGAL cut-off value, mortality was found to be higher in patients with a NGAL level higher than 217.50 (log-rank (Mantel-Cox) test, chi 2 = 15.540,p< 0.001). Conclusion In this study, we found that high levels of NGAL at the time of diagnosis were associated with poor prognosis in HCC patients.
Neutrophil to lymphocyte ratio is increased in chronic helicobacter pylori infection and returns to normal after successful eradication
(2016) Asil, Mehmet; Dertli, Ramazan
Amaç: Nötrofil lenfosit oranı birçok hastalıkla ilişkisi gösterilmiş ucuz bir belirteçtir. Biz de bu çalışmada kronik Helicobacter pylori enfeksiyonu olan hastalarda nötrofil lenfosit oranını araştırmayı planladık. Gereç ve Yöntem: Kronik Helicobacter pylori enfeksiyonu olan 286 hasta ve 130 Helicobacter pilori (-) kontrol grubuna ait klinik ve laboratuar verileri retrospektif olarak analiz edildi. Bulgular: Ortalama nötrofil lenfosit oranı Helicobacter pylori () grupta 1,980,76 ve Helicobacter pylori (-) grupta 1,640,44 olup aradaki fark istatistiksel olarak anlamlıydı (p0,001). Ortalama lökosit ve nötrofil sayıları, Helicobacter pylori () grupta sırasıyla 7,281,55/?L ve 4,271,17 /?L ve Helicobacter pylori (-) grupta sırasıyla 6,901,38 /?L ve 3,821,04 /?L olarak saptanmış olup her iki grup arasındaki fark gerek ortalama lökosit sayısı açısından (p0,011) gerek se ortalama nötrofil sayısı açısından (p0,001) anlamlı bulundu. Her iki grup arasında ortalama lenfosit sayısı, hemoglobin, hematokrit, RDW, trombosit sayısı, MPV, PDW açısından fark yoktu. 253 hastaya Helicobacter pylori eradikasyon tedavisi verilmişti. 76 hastada tedavi sonrası hematolojik veriler mevcuttu. Bu hastaların 45'inde (%59,2) eradikasyon tedavisinin başarılı olduğu (grup 1), 31 hastada (%40,8) ise eradikasyonun başarısız olduğu görüldü. Grup 1 için tedavi öncesi ve sonrası ortalama nötrofil lenfosit oranlarının 1,990,75 ve 1.700.60 olduğu ve aradaki farkın istatistiksel olarak anlamlı olduğu (p0,004), grup 2 için ise tedavi öncesi ve sonrası ortalama nötrofil lenfosit oranlarının 1,930,59 ve 1.760.56 olduğu ve aradaki farkın istatistiksel olarak anlamlı olmadığı görüldü. Sonuç: Kronik Helicobacter pylori enfeksiyonunda nötrofil lenfosit oranı artmıştır. Başarılı eradikasyon tedavisi sonrası artmış nötrofil lenfosit oranı normale döner.
The Neutrophil-to-Lymphocyte Ratio as A Noninvasive Marker in Patients with Biopsy-Proven Non-Alcoholic Steatohepatitis
(Aves, 2016) Asil, Mehmet; Dertli, Ramazan
Objective: Non-alcoholic fatty liver disease is a global health problem with an increasing prevalence. The neutrophil-to-lymphocyte ratio is a cheap inflammatory parameter that can be easily calculated from routine complete blood count tests. This study was designed to investigate the neutrophil-to-lymphocyte ratio in patients with non-alcoholic steatohepatitis and simple hepatosteatosis. Methods: Fifteen patients with biopsy-proven non-alcoholic steatohepatitis, 65 patients with simple steatosis diagnosed with abdominal ultrasound, and 65 healthy controls were included. Anthropometric measurements were obtained during a routine physical examination. The neutrophil-to-lymphocyte ratio was calculated from routine complete blood count tests, and its relationship with various clinical and laboratory parameters was analyzed. Results: The mean neutrophil-to-lymphocyte ratio was 2.16+/-0.49 in the patients with non-alcoholic steatohepatitis, 1.62+/-0.43 in the patients with simple steatosis, and 1.51+/-0.31 for healthy controls; the difference among the groups of patients were statistically significant (p<0.001). A paired analysis revealed that patients with non-alcoholic steatohepatitis had a significantly higher neutrophil-to-lymphocyte ratio than patients with simple steatosis and healthy controls, whereas the difference between the latter two groups of patients was not statistically significant. The neutrophil-to-lymphocyte ratio was not associated with the degree of steatosis on performing abdominal ultrasound and with histological findings of liver biopsies (p>0.05). ROC analyses for the neutrophil-to-lymphocyte ratio to differentiate patients with steatohepatitis revealed an AUC of 0.868 (95% CI: 0.781-0.956) and 86.5% sensitivity and 81% specificity for the selected cut-off value of 1.793. Conclusion: The results of this study showed that the neutrophil-to-lymphocyte ratio was higher in patients with steatohepatitis than in patients with simple steatosis and healthy controls. Taking into account that the difference between patients with simple steatosis and healthy controls was not statistically significant, the increased neutrophil-to-lymphocyte ratio in the patients with steatohepatitis can be attributed to a low level of systemic inflammation accompanying the hepatic inflammation.
A Novel Marker Affecting Survival in Acute Non-variceal Upper Gastrointestinal Bleeding: Cardiac Troponin I
(Galenos Publ House, 2021) Dertli, Ramazan; Biyik, Murat; Yolacan, Ramazan; Keskin, Muharrem; Karakarcayildiz, Ahmet; Kayar, Yusuf; Ataseven, Huseyin
Introduction: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is an important public health problem with high rates of morbidity and mortality. ANVUGIB results in hypovolemia, hypotension, and shock, increasing cardiac oxygen use and may cause elevated serum levels of cardiac troponin (cTn). In this study, we aimed to evaluate whether elevated cTnI has clinical significance in patients with ANVUGIB. Methods: A total of 62 patients diagnosed with ANVUGIB whose serum cTnI levels were studied at the time of admission and follow-up in our clinic from January 2015 to January 2016 were included in the study. Patients with acute cardiac diseases that may cause elevated cTn were excluded from the study. Results: Forty-three of the patients were male (69.4%), and the mean age of all patients was 71.52 +/- 13.30 years. The mean cTnI level was 0.042 +/- 0.097 in all patients, with cTnI levels higher than the reference value in nine (14.5%) patients. In logistic regression analysis, the factors found to contribute to cTnI were tachycardia, chronic kidney disease, and coronary artery disease. In receiver operating characteristic analysis, cutoff values of 0.025 and 6.5 were found for cTnI and the Rockall score, respectively. In addition, cTnI and the Rockall score were shown to affect survival [log-rank (Mantel-Cox) test: p=0.011; log-rank (Mantel-Cox) test: p=0.014; respectively]. Conclusion: We believe that serum cTnI levels studied during the first admission will be found useful as a biomarker in addition to the other existing risk determination systems, in order to identify patients at risk, even if findings of acute coronary syndrome are not observed in patients presenting with ANVUGIB.
A polypoid mass in the common bile duct
(Aves, 2016) Asil, Mehmet; Dertli, Ramazan; Biyik, Murat; Oltulu, Pembe; Ataseven, Huseyin; Polat, Hakki; Demir, Ali
[Abstract Not Availabe]
A polypoid mass in the common bile duct
(2016) Asıl, Mehmet; Bıyık, Murat; Oltulu, Pembe; Ataseven, Hüseyin; Dertli, Ramazan; Polat, Hakkı; Demir, Ali
Question: A 73-year-old woman with a prior history of cholecystectomy operation due to cholelithiasis was admitted to our clinic with complaints of abdominal pain in the epigastrium and right upper quadrant. Laboratory studies were unremarkable: Hb: 14.2 g/dL, hematocrit: 42.8%, WBC: 6000 /μL, platelet: 167000/μL, AST: 14 U/L, ALT: 16 U/L, ALP: 69 U/L, GGT: 42 U/L, total bilirubin: 0.57 mg/dL, and direct bilirubin: 0.32 mg/dL. Abdominal ultrasound examination showed dilatation of intrahepatic bile ducts. Endoscopic ultrasound (EUS) (Figure 1) and endoscopic retrograde cholangiopancreatography (ERCP) were then performed (Figure 2). During ERCP, the common bile duct was explored with a stone extraction balloon and a polypoid mass of 0.5 cm (Figure 3) came out of the common bile duct lumen, which was retrieved using a netted snare and sent to the pathology laboratory for histological examination (Figure 4).

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