Publications by authors named "Alpaslan Tanoğlu"

88 Publications

Associations between Gilbert's syndrome and personality characteristics.

Trends Psychiatry Psychother 2021 Apr 2. Epub 2021 Apr 2.

Department of Gastroenterology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.

Objective: Gilbert's syndrome (GS) is a benign genetic disorder that is characterized by intermittent mild jaundice in which the liver doesn't process bilirubin properly. The aim of this study was to determine whether GS patients have a different personality structure and if there are associations between properties of temperament and character and total bilirubin levels.

Methods: A total of 1665 young male individuals aged from 19 to 30 who were admitted for occupational examinations were included in this study. Careful patient history was taken, a detailed physical examination was conducted, and hematologic and biochemical tests and abdominal ultrasonography were performed. The Turkish version of the Temperament and Character Inventory (TCI) was administered to all participants. 81 patients diagnosed with GS and 150 randomly chosen healthy individuals (control group) were investigated with comparison and correlation analyses.

Results: GS patients had higher scores than healthy controls for disorderliness (NS4) (p = 0.018), sentimentality (RD1) (p = 0.042), and fatigability (HA4) (p = 0.03). Moreover, Gilbert syndrome patients scored lower than controls for empathy (C2) (p = 0.041) and transpersonal identification (ST2) (p = 0.044). Bilirubin levels were positively associated with disorderliness (NS4) (r = 0.141, p = 0.032) and fatigability (HA4) (r = 0.14, p = 0.033).

Conclusions: GS patients may have some different personality characteristics from healthy individuals. This study is an initial exploration of the personality structure of GS patients and the findings should be interpreted with caution. Further prospective studies are needed to identify the relationship between Gilbert disease and personality characteristics.
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http://dx.doi.org/10.47626/2237-6089-2020-0003DOI Listing
April 2021

A very uncommon clinical entity: Lansoprazole-induced symptomatic hyponatremia in a young woman.

Turk J Gastroenterol 2020 Dec;31(12):957-959

Department of Internal Medicine, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.5152/tjg.2020.19374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928252PMC
December 2020

Evaluation of serum CXC chemokine ligand 16 (CXCL16) as a novel inflammatory biomarker for Familial Mediterranean Fever disease.

Turk J Med Sci 2020 Dec 11. Epub 2020 Dec 11.

Background/aim: FMF is a disease that is mainly diagnosed with clinical features. Several well-known inflammatory markers increase in FMF. However, there is still a need for diagnostic tests for specifying FMF and monitoring inflammatory activity. CXCL16 is a chemokine produced by inflammatory cells that demonstrate efficacy in the acute phase response. In this study, we aimed to investigate the relationship between CXCL16 levels and FMF disease and to evaluate CXCL16 levels as a novel biomarker for FMF.

Materials And Methods: Fifty-three male patients diagnosed with FMF and sixty healthy individuals were included in this cross-sectional study. Blood samples were taken in the first 24 hours of the attack periods. Serum soluble CXCL16 was evaluated by ELISA method.

Results: CXCL16 (p<0.001), erythrocyte sedimentation rate (p<0.001), C-reactive protein (p<0.001) and fibrinogen (p=0.005) were significantly higher in FMF group than in control group. Receiver operating characteristic (ROC) curve analysis revealed a cut off value of CXCL16 as 2.68 ng/ml with 83% sensitivity and 68% specificity (p<0.001). Logistic regression analysis indicated that high CXCL16 and erythrocyte sedimentation rate levels were predictive parameters for FMF disease (OR 8.31; 95% CI 2.59-26.62; p <0.001) (OR 1.27; 95% CI 1.12-1.44; p<0.001). There was no correlation between CXCL16 levels and attack frequency and disease duration (p=0.395, p=0.956).

Conclusion: To the best of our knowledge, this is the first study evaluating serum soluble CXCL16 levels as a biomarker for FMF. CXCL16 levels were significantly higher and were predictive for monitoring inflammatory activity in patients with FMF. CXCL16 may be a promising biomarker for FMF diagnosis.
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http://dx.doi.org/10.3906/sag-2010-64DOI Listing
December 2020

Determination of B- and T- cell epitopes for Helicobacter pylori cagPAI: An in silico approach.

Turk J Gastroenterol 2020 Oct;31(10):713-720

Department of Gastroenterology, Sultan Abdulhamit Training and Research Hospital, İstanbul, Turkey.

Background/aims: Helicobacter pylori is classified as a gram-negative bacteria and can cause significant diseases, including gastric cancer, mucosa-associated lymphoid tumor, peptic ulcer, and chronic gastritis. Recent studies have shown that some autoimmune diseases are also associated with H. pylori. In the past decades, polymorphisms of certain genes of H. pylori, mechanisms and strains of H. pylori, and new therapeutic approaches have continued to be defined. Bioinformatic tools continue to be used in drug design and vaccine design. This study aimed to investigate the cag pathogenicity island (cagPAI) of H. pylori using an in silico approach, which could contribute to vaccine studies.

Materials And Methods: The pathogenicity island of H. pylori was obtained from GenBank and analyzed with ClustalW software. Structures of cag Virb11 (Hp0525) and an inhibitory protein (Hp1451) were obtained, and codon optimization and secondary and tertiary structure prediction for the cagPAI of H. pylori were analyzed using Garnier-Osguthorpe-Rabson IV secondary structure prediction method and self-optimized prediction method with alignment software. The BcePred prediction server was used to distinguish linear B-cell epitopes, and prediction of T-cell was obtained with NetCTL and MHCPred.

Results: According to the physicochemical parameters, the cagPAI of H. pylori was analyzed and found to be stable, and 2 B-cell epitopes of cagPAI of H. pylori and 2 T-cell epitopes of cagPAI were found in this study.

Conclusion: B- and T-cell epitopes that we have identified can induce both humoral and cellular immune responses. Thus, these epitopes have a potential for vaccine studies. Consequently, this in silico analysis should be combined with other pieces of evidence, including experimental data, to assign function.
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http://dx.doi.org/10.5152/tjg.2020.19154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659908PMC
October 2020

Ankaferd hemostat (ABS) as a potential mucosal topical agent for the management of COVID-19 syndrome based on its PAR-1 inhibitory effect and oestrogen content.

Med Hypotheses 2020 Oct 31;143:110150. Epub 2020 Jul 31.

Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

COVID-19 due to the SARS-CoV-2 infection is a multi-systemic immune syndrome affecting mainly the lungs, oropharyngeal region, and other vascular endothelial beds. There are tremendous ongoing efforts for the aim of developing drugs against the COVID-19 syndrome-associated inflammation. However, currently no specific medicine is present for the absolute pharmacological cure of COVID-19 mucositis. The re-purposing/re-positioning of already existing drugs is a very important strategy for the management of ongoing pandemy since the development of a new drug needs decades. Apart from altering angiotensin signaling pathways, novel drug candidates for re-purposing comprise medications shall target COVID-19 pathobiology, including pharmaceutical formulations that antagonize proteinase-activated receptors (PARs), mainly PAR-1. Activation of the PAR-1, mediators and hormones impact on the hemostasis, endothelial activation, alveolar epithelial cells and mucosal inflammatory responses which are the essentials of the COVID-19 pathophysiology. In this context, Ankaferd hemostat (Ankaferd Blood Stopper, ABS) which is an already approved hemostatic agent affecting via vital erythroid aggregation and fibrinogen gamma could be a potential topical remedy for the mucosal management of COVID-19. ABS is a clinically safe and effective topical hemostatic agent of plant origin capable of exerting pleiotropic effects on the endothelial cells, angiogenesis, cell proliferation and vascular dynamics. ABS had been approved as a topically applied hemostatic agent for the management of post-surgical/dental bleedings and healing of infected inflammatory mucosal wounds. The anti-inflammatory and proteinase-activated receptor axis properties of ABS with a considerable amount of oestrogenic hormone presence highlight this unique topical hemostatic drug regarding the clinical re-positioning for COVID-19-associated mucositis. Topical ABS as a biological response modifier may lessen SARS-CoV-2 associated microthrombosis, endothelial dysfunction, oropharyngeal inflammation and mucosal lung damage. Moreover, PAR-1 inhibition ability of ABS might be helpful for reducing the initial virus propagation and mocasal spread of COVID-19.
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http://dx.doi.org/10.1016/j.mehy.2020.110150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392953PMC
October 2020

Polymorphisms in Toll-like receptors 1, 2, 5, and 10 are associated with predisposition to Helicobacter pylori infection.

Eur J Gastroenterol Hepatol 2020 09;32(9):1141-1146

Department of Endocrinology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.

Objective: Toll-like receptors (TLRs) are significant receptors to the innate immune system which symbolizes a family of pattern recognition receptors. We aimed to investigate associations between rs4833095 polymorphism of TLR1, rs3804099 polymorphism of TLR2, rs5744174 polymorphism of TLR5, and rs10004195 polymorphism of TLR10 in dyspeptic individuals with Helicobacter pylori infection.

Methods: Genomic DNA was isolated and genotyping of rs4833095 polymorphism in TLR1, rs3804099 polymorphism in TLR2, rs5744174 polymorphism in TLR5, and rs10004195 polymorphism in TLR10 were investigated in 400 individuals (205 in dyspeptic individuals with H. pylori-positive subjects and 195 dyspeptic individuals with H. pylori-negative subjects) by real-time PCR. Statistical analysis was performed by Pearson's Chi-square test.

Results: According to our study; rs4833095 polymorphism in TLR1 C allele, rs3804099 polymorphism in TLR2 C allele, rs5744174 polymorphism in TLR5 C allele, and rs10004195 polymorphism in TLR10 A allele increased the risk of H. pylori infection [odds ratio (OR), 2.01; 95% confidence interval (CI), 1.39-3.16; OR, 1.78; 95% CI, 1.19-2.6; OR, 1.87; 95% CI, 1.25-2.78; OR, 2.66; 95% CI, 1.72-4.099, respectively].

Conclusion: This is the first study that investigates TLRs in H. pylori infection in Turkey. Our findings may support the hypothesis that polymorphisms in certain TLRs may cause a genetic predisposition to H. pylori-related gastric problems.
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http://dx.doi.org/10.1097/MEG.0000000000001797DOI Listing
September 2020

Clinical utility of mean platelet volume and related scores for assessing the severity of hepatic fibrosis in chronic hepatitis C patients.

Authors:
Alpaslan Tanoglu

Eur J Gastroenterol Hepatol 2020 05;32(5):664-665

Department of Gastroenterology, University of Health Sciences, Istanbul, Turkey.

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http://dx.doi.org/10.1097/MEG.0000000000001657DOI Listing
May 2020

treatment in Turkey: Current status and rational treatment options.

North Clin Istanb 2020 11;7(1):87-94. Epub 2019 Jul 11.

Department of Gastroenterology, Acibadem University, Istanbul, Turkey.

According to the TURHEP study, the prevalence of in Turkey is 82.5%. After FDA approval in 1995, many countries have used standard triple therapy (proton pump inhibitor 40 mg b.i.d clarithromycin 500 mg b.i.d and amoxicillin 1 gr b.i.d) for treatment. In the beginning, eradication rates were above 90% in many countries; however, current studies have demonstrated a prominent decrease in successful treatment rates, even down to 60%. This unfavorable reduction stimulated searches for new treatment protocols. Treatment protocols differ according to country, prevalence, cost-effectiveness, antibiotic resistance, CYP2C19 polymorphism and eradication rates. Thus, each country/region needs to revise its own therapeutic results and the efficacy of various eradication regimens in the treatment of . This report aims to review the current status of treatment in Turkey and to provide recommendations for rational therapeutic considerations for the eradication of the bacterium.
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http://dx.doi.org/10.14744/nci.2019.62558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103748PMC
July 2019

Presepsin:albumin ratio and C-reactive protein:albumin ratio as novel sepsis-based prognostic scores : A retrospective study.

Wien Klin Wochenschr 2020 Apr 14;132(7-8):182-187. Epub 2020 Feb 14.

Department of Internal Medicine, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.

Objective: To investigate the prognostic value of the presepsin:albumin ratio and C‑reactive protein:albumin ratio in patients with sepsis in the intensive care unit (ICU).

Methods: A total of 228 (129 males and 99 females) patients with newly diagnosed sepsis were included in the study. The relationship between the C‑reactive protein:albumin ratio, presepsin:albumin ratio, clinicopathologic parameters, and overall survival were investigated. The associations between C‑reactive protein:albumin ratio and presepsin:albumin ratio were evaluated alongside other inflammation-based prognostic scores such as quick Sepsis Related Organ Failure Assessment (qSOFA).

Results: The presepsin:albumin ratio was significantly higher in non-survivors (p < 0.01). Patients with a high presepsin:albumin ratio had worse overall survival compared with patients with high C‑reactive protein:albumin ratio levels (p < 0.001).

Conclusion: Presepsin and presepsin:albumin ratio are markers of adverse prognosis in patients with sepsis and are superior to C‑reactive protein and C‑reactive protein:albumin ratio for this purpose. Presepsin:albumin ratio may be a novel marker of poor prognosis in patients with sepsis in intensive care units.
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http://dx.doi.org/10.1007/s00508-020-01618-9DOI Listing
April 2020

Drug-induced Liver Injury Caused by Phenprobamate: Strong Probability Due to Repeated Toxicity.

Euroasian J Hepatogastroenterol 2019 Jan-Jun;9(1):49-51

Department of Gastroenterology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.

Drug-induced liver injury (DILI) is an important cause of morbidity and mortality. DILI can even cause acute liver failure and the need for liver transplantation. Identifying DILI may be particularly difficult because it is actually an exclusion diagnosis and individuals are usually exposed to several drugs during a lifetime. Causality assessment methods are needed for objective diagnosis. The most common methods are; updated Roussel Uclaf causality assessment method (RUCAM), Narenjo adverse drug reaction probability scale and Maria and Victorino (M&V) causality assessment scale. Phenprobamate is a widely used muscle relaxant. Herein we report a rare case of repeated DILI caused by phenprobamate and review the objective diagnostic process for hepatotoxicities. Physicians should be aware of the potential adverse effects of this drug, including hepatotoxicity. Duzenli T, Tanoglu A, Drug-induced Liver Injury Caused by Phenprobamate: Strong Probability Due to Repeated Toxicity. Euroasian J Hepatogastroenterol 2019;9(1) :49-51.
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http://dx.doi.org/10.5005/jp-journals-10018-1295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969320PMC
January 2020

Pentoxifylline has favorable preventive effects on experimental chronic pancreatitis model.

Scand J Gastroenterol 2020 Feb 16;55(2):236-241. Epub 2020 Jan 16.

Department of Internal Medicine, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.

To investigate the protective efficacy of pentoxifylline through biochemical parameters and histopathological scores in a caerulein- and alcohol-induced experimental model of chronic pancreatitis in rats. A model of chronic pancreatitis with caerulein and alcohol was created in female rats of the genus Sprague Dawley. Pentoxifylline was administered in doses of 25 mg/kg (low dose) and 50 mg/kg (high dose) as a protective agent. Each group contained 8 animals. The groups were: group 1 (control group); caerulein + alcohol, group 2 (low-dose pentoxifylline group); caerulein + alcohol + pentoxifylline 25 mg/kg, group 3 (high-dose pentoxifylline group); caerulein + alcohol + pentoxifylline 50 mg/kg, group 4 (placebo); caerulein + alcohol + saline, group 5 (sham group); only saline injection.Rats were sacrificed 12 h after the last injection, and TNF-α, TGF-β, MDA, and GPx concentrations were measured in blood samples. The histopathologic examination was conducted by a pathologist who was unaware of the groups. The biochemical results of the treatment groups (group 2 and group 3) were statistically significantly lower compared with the control group (group 1) ( < .05). The difference between the low-dose treatment group (group 2) and high-dose treatment group (group 3) was significant in terms of biochemical parameters ( < .05). The difference between group 2 and the control group was not significant in terms of histopathologic scores ( > .05), whereas the difference between the group 3 and the control group was statistically significant ( < .05). As a result, pentoxifylline, which has anti-inflammatory and antioxidant properties, was shown to have protective efficacy in an experimentally generated model of chronic pancreatitis.
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http://dx.doi.org/10.1080/00365521.2020.1712471DOI Listing
February 2020

Midkine level may be used as a noninvasive biomarker in Crohn’s disease

Turk J Med Sci 2020 04 9;50(2):324-329. Epub 2020 Apr 9.

Department of Gastroenterology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey

Background/aim: Crohn’s disease (CD) is a kind of inflammatory bowel disease. Midkine (MDK) is an endogenous inflammatory marker. We aimed to investigate the relationship between MDK levels and inflammation and hence determine whether MDK can be used as a noninvasive biomarker in active CD.

Materials And Methods: Sixty-five consecutive patients over the age of 18 with CD and 36 healthy controls were included in this study. CD patients’ venous blood samples were taken before treatment. Serum MDK levels were determined in human plasma samples by enzyme-linked immunosorbent assay (ELISA) method.

Results: The mean age of the study patients was 44.8 ± 12.5 years, 35 patients were female, and 30 were male. Of these 65 patients, 37 had active CD and 28 were in the remission phase. MDK levels were significantly higher in active and remission CD than in healthy controls (P = 0.01, P = 0.038, respectively).

Conclusion: e report that there is an association between MDK levels and CD activation, and therefore with enhanced inflammation. MDK levels were significantly correlated with inflammatory indices. In line with our findings, we suggest the theory that MDK inhibitors may be useful in treating Crohn’s disease.
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http://dx.doi.org/10.3906/sag-1904-167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164751PMC
April 2020

Clinicopathological profile of gastrointestinal tuberculosis: a multinational ID-IRI study.

Eur J Clin Microbiol Infect Dis 2020 Mar 22;39(3):493-500. Epub 2019 Nov 22.

Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.

Data are relatively scarce on gastro-intestinal tuberculosis (GITB). Most studies are old and from single centers, or did not include immunosuppressed patients. Thus, we aimed to determine the clinical, radiological, and laboratory profiles of GITB. We included adults with proven GITB treated between 2000 and 2018. Patients were enrolled from 21 referral centers in 8 countries (Belgium, Egypt, France, Italy, Kazakhstan, Saudi Arabia, UK, and Turkey). One hundred four patients were included. Terminal ileum (n = 46, 44.2%), small intestines except terminal ileum (n = 36, 34.6%), colon (n = 29, 27.8%), stomach (n = 6, 5.7%), and perianal (one patient) were the sites of GITB. One-third of all patients were immunosuppressed. Sixteen patients had diabetes, 8 had chronic renal failure, 5 were HIV positive, 4 had liver cirrhosis, and 3 had malignancies. Intestinal biopsy samples were cultured in 75 cases (78.1%) and TB was isolated in 65 patients (86.6%). PCR were performed to 37 (35.6%) biopsy samples and of these, 35 (94.6%) were positive. Ascites samples were cultured in 19 patients and M. tuberculosis was isolated in 11 (57.9%). Upper gastrointestinal endoscopy was performed to 40 patients (38.5%) and colonoscopy in 74 (71.1%). Surgical interventions were frequently the source of diagnostic samples (25 laparoscopy/20 laparotomy, n = 45, 43.3%). Patients were treated with standard and second-line anti-TB medications. Ultimately, 4 (3.8%) patients died and 2 (1.9%) cases relapsed. There was a high incidence of underlying immunosuppression in GITB patients. A high degree of clinical suspicion is necessary to initiate appropriate and timely diagnostic procedures; many patients are first diagnosed at surgery.
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http://dx.doi.org/10.1007/s10096-019-03749-yDOI Listing
March 2020

Neutrophil-to-lymphocyte ratio alone may not be a true indicator of the severity of acute pancreatitis.

Turk J Gastroenterol 2019 10;30(10):937

Department of Gastroenterology, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.

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http://dx.doi.org/10.5152/tjg.2019.18856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812943PMC
October 2019

Boceprevir-induced Herpes Zoster.

Euroasian J Hepatogastroenterol 2018 Jul-Dec;8(2):161-162. Epub 2019 Feb 1.

Department of Gastroenterology, Ankara Training and Research Hospital, Ankara, Turkey.

Herpes zoster is caused by reactivation of the varicella zoster virus (VZV), that attacks peripheral or cranial nerves and result in painful cutaneous inflammation. Boceprevir is a protease inhibitor which used as a new therapeutic agent for chronic hepatitis C infection. Boceprevir associated herpes zoster is extremely rare condition. We present herpes zoster infection assosiated Boceprevir in patint with chronic hepatitis C. Babali A, Cakal B, Tanoglu A, Karaahmet F, Kekilli M. Boceprevir-induced Herpes Zoster. Euroasian J Hepatogastroenterol, 2018;8(2):161-162.
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http://dx.doi.org/10.5005/jp-journals-10018-1282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395489PMC
February 2019

Dual FAAH and MAGL inhibition might play a key role in visceral pain.

Turk J Gastroenterol 2018 09;29(5):625-626

Department of Gastroenterology and Hepatology, Gülhane Training and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.5152/tjg.2018.18401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284613PMC
September 2018

Risk factors for recurrences in patients with hepatitis C virus after achieving a sustained virological response: a multicentre study from Turkey.

Infez Med 2018 Jun;26(2):133-138

Department of Internal Medicine, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.

In this study, we aimed to determine the late relapse rate in hepatitis C patients with sustained virological response after interferon-based regimens, and evaluated the predictors of late relapse while comparing the real-life data of our country with that of others. A multicenter retrospective study was performed to investigate the data of patients infected with HCV who obtained sustained virological response after classical or pegylated interferon alpha (PegIFNα) and ribavirin (RBV) for 48 weeks. Sustained virological response was based on negative HCV RNA level by PCR at the end of six months after the therapy. The information of patients enrolled in the study was retrieved from the hospital computer operating system and outpatient follow-up archives. We evaluated the age, gender, HCV RNA levels, HCV genotype, six-month and further follow-up of patients with sustained virologic response, presence of cirrhosis, steatosis and relapse. In all, 606 out of 629 chronic hepatitis C patients (mean age was 53±12 years; 57.6% of them were female) with sustained virological response were evaluated. We excluded 23 patients who relapsed within six months after the end of treatment (EOT). The mean follow-up period of the patients was 71 months (range: 6-136) after therapy. Late relapse rate was 1.8% (n=11) in all patients. Univariate Cox proportional hazard regression models identified that cirrhosis and steatosis were associated with the late relapse [(p = 0.027; Hazard Ratio (HR) 2.328; 95% confidence interval (CI): 1.309-80.418), (p = 0.021; HR 1.446; 95% CI: 1.243-14.510, respectively]. In multivariable Cox regression analysis, steatosis was the only independent risk factor for late relapse (p = 0.03; HR 3.953; 95% CI: 1.146-13.635). Although the late relapse rate was approximately 2% in our study, clinicians should consider that pretreatment steatosis may be an important risk factor for late relapse.
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June 2018

Efficacy of tocilizumab treatment in cerulein-induced experimental acute pancreatitis model in rats.

Turk J Gastroenterol 2017 Nov 25;28(6):485-491. Epub 2017 Oct 25.

Department of Internal Medicine, Sultan Abdulhamit Training and Research Hospital, İstanbul, Turkey.

Background/aims: Acute pancreatitis (AP) is a disease that can cause local and systemic complications that may have high morbidity and mortality. Currently, there is not any specific treatment for AP. In this study, we created an experimental model of AP in rats, and we aimed to demonstrate the histological effectiveness of tocilizumab treatment that antagonizes interleukin-6 (IL-6), one of the key cytokines in the development of AP.

Materials And Methods: Forty-eight rats were divided into six groups for this study. AP model was created by subcutaneous injections of cerulein (20 μg/kg) four times at 1-h intervals. Tocilizumab 4 mg/kg was administered to one of the treatment groups and 8 mg/kg to the other treatment group intraperitoneally. The effects of tocilizumab were revealed by examining pancreatic tissue of the rats histopathologically according to the Schonberg scoring system.

Results: A comparison between tocilizumab treatment group and AP control group provides statistically significant improvement in AP (p<0.0001). Furthermore, the dose of 8 mg/kg is shown to be more effective than 4 mg/kg (p=0.004).

Conclusion: Our study points out that tocilizumab may be an effective agent for pancreatitis treatment.
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http://dx.doi.org/10.5152/tjg.2017.16738DOI Listing
November 2017

An unusual method to diagnose a rare disease: Upper gastrointestinal endoscopy.

Turk J Gastroenterol 2017 11 19;28(6):522-523. Epub 2017 Sep 19.

Department of Gastroenterology, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.

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http://dx.doi.org/10.5152/tjg.2017.17224DOI Listing
November 2017

Evaluation of endothelial dysfunction in patients with nonalcoholic fatty liver disease: Association of selenoprotein P with carotid intima-media thickness and endothelium-dependent vasodilation.

Clin Res Hepatol Gastroenterol 2017 Oct 29;41(5):516-524. Epub 2017 Jul 29.

GATA Haydarpasa Training Hospital, Department of Gastroenterology, 34668 Uskudar, Istanbul, Turkey.

Background: In patients with NAFLD, there is an increased risk of cardiovascular disease (CVD). Selenoprotein P (SelP), a hepatokine, is associated with insulin resistance (IR) and serum SelP was found to be elevated in patients with NAFLD.

Aim: This study aimed to determine the risk of CVD in NAFLD patients and the association of serum SelP levels with this NAFLD related CVD risk.

Methods: Ninety-three patients with NAFLD and 37 healthy controls were included in the study. Complete blood count, C-reactive protein (CRP), fasting glucose, serum lipid levels, and SelP levels were tested from fasting blood samples. Moreover, body mass index (BMI), HOMA-IR, carotid intima-media thickness (cIMT) and flow-mediated dilatation (FMD) were measured.

Results: In patients with NAFLD, the FMD ratio was significantly lower than in controls (P=0.027). cIMT measurements were similar in both groups (P=0.996). Serum SelP levels were significantly higher than controls (P<0.001). SelP levels were significantly correlated with BMI, fasting glucose, LDL-cholesterol and HOMA-IR (r=0.395, P<0.001; r=0.322, P=0.002; r=0.353, P<0.001; r=0.521, P<0.001, respectively). Also, SelP levels were significantly lower and correlated with FMD (r=-0.674, P<0.001). SelP, ESR and CRP were significantly higher (P<0.05) and FMD ratios were significantly lower (P<0.05) in patients with nonalcoholic steatohepatitis (NASH) when compared to patients with simple steatosis.

Conclusion: These results suggest that in young NAFLD patients without additional comorbidities, there is an increased risk of CVD. FMD may be a better predictor for assessment of CVD risk when compared with cIMT. We assume that there could also be an important role of SelP in the pathogenesis of NASH.
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http://dx.doi.org/10.1016/j.clinre.2017.01.005DOI Listing
October 2017

Is computerised tomography better than fibreoptic gastroscopy for early detection of gastric varices?

Prz Gastroenterol 2017 26;12(1):34-37. Epub 2016 Oct 26.

Department of Gastroenterology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.

Introduction: Video endoscopic diagnosis of gastric varices is particularly limited, owing to the deep submucosal or subserosal location of the varices and the normal appearance of the overlying mucosa.

Aim: We present and emphasise the value of computerised tomography (CT) examination in the early detection of gastric varices (GVs).

Material And Methods: In this retrospective study, a total of 216 consecutive patients with cirrhosis were evaluated at the Turkiye Yuksek Ihtisas Training and Research Hospital between September 2008 and March 2011.

Results: One hundred and thirty patients with cirrhosis were enrolled in the study. The mean age of the male (88 cases) patients was 59.45 ±2.42 years, and the mean age of the female (42 cases) patients was 56.29 ±1.14 years. Computerised tomography identified oesophageal varices (EVs) in 103/130 patients, and endoscopy identified EVs in 103/130 patients. Computerised tomography identified GVs in 86/130 patients, and endoscopy identified GVs in 26/130 patients. After endoscopic elastic band ligation (EBL), CT identified GVs in 22/26 patients, and endoscopy identified GVs in 7/26 patients.

Conclusions: Gastric varices lie in the submucosa, deeper than EVs, and distinguishing GVs from gastric rugae may be difficult with video endoscopy. This study demonstrated that CT is a sensitive method for early detection of GVs and has been used previously in the evaluation of GVs.
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http://dx.doi.org/10.5114/pg.2016.63284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360658PMC
October 2016

Evaluation of endothelial dysfunction in patients with familial Mediterranean fever: the relationship between the levels of asymmetric dimethylarginine and endocan with carotid intima-media thickness and endothelium-dependent vasodilation.

Clin Rheumatol 2017 Sep 10;36(9):2071-2077. Epub 2017 Jan 10.

Gastroenterology Department, GATA Haydarpasa Training Hospital, Uskudar, 34668, Istanbul, Turkey.

It has been suggested that there is an ongoing subclinical inflammation in familial Mediterranean fever (FMF) patients also in attack-free periods as well. Due to this ongoing inflammation, endothelial dysfunction (ED) may develop. Previously, ED has been suggested to increase the risk of the atherosclerosis and cardiovascular disease (CVD). Endocan is recognized as a specific molecule of the endothelium and has been shown to increase in some cases associated with inflammation. However, there is not sufficient data whether those with FMF could develop ED in the early period of life. In this study, we aimed to investigate ED and its relation with endocan in young FMF patients. A total of 57 male patients diagnosed with FMF according to the Tel Hashomer criteria and a total of 33 healthy males with similar characteristics to the patient group were included in this research. Complete blood count, erythrocyte sedimentation rate (ESR), fibrinogen, serum glucose, serum LDL cholesterol (LDL-C) and triglyceride (TG), asymmetric dimethylarginine (ADMA), and endocan levels were tested from fasting blood samples. Moreover, carotid intima-media thickness (CIMT) and flow-mediated dilatation (FMD) were measured. The endocan levels of the FMF patients during an attack-free period were significantly higher than those of the control group (p < 0.001). On the other hand, FMD measurements were significantly lower among FMF patients (p < 0.001). ADMA levels were higher in the patient group; however, this difference was similar (p > 0.05). CIMT values were similar among FMF patients and healthy controls (p > 0.05). These results have suggested that ED may develop in the patients with FMF who have no additional CVD risk, even during young adulthood, and endocan may be a favorable biomarker at demonstration of ED than ADMA among FMF patients.
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http://dx.doi.org/10.1007/s10067-016-3532-2DOI Listing
September 2017

Comparison of the Elecsys HBsAg II Assay and the Architect Assay for Quantification of hepatitis B surface antigen in patients with chronic hepatitis B.

Infez Med 2016 12;24(4):287-292

Gata Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

Quantitative hepatitis B surface antigen (HBsAg) is a valuable tool in hepatitis B virus (HBV) disease diagnosis and management for evaluating the effectiveness of antiviral therapy. The aim of the current research was to compare the performances of the Elecsys HBsAg II and Abbott Architect HBsAg assays in chronic hepatitis B (CHB) patients. Between May 2014 and December 2014, 72 CHBs were tested using Abbott Architect HBsAg QT and Roche Elecsys HBsAg II assay. After transformation to log (10) IU/mL, the results of the two assays were compared using the interclass correlation test, the Pearson correlation test and Bland-Altman analyses. We also analyzed all the parameters in on-treatment patients and naive patients with Pearson correlation test. There was a significant overall correlation between the Elecsys and Architect assays. We also analyzed all the parameters in naive and on-treatment patients. There was a significantly good correlation between the two assays in untreated patients and on-treatment patients. In this study, there was a significant correlation between the results of the Elecsys HBsAg II and Abbott Architect HBsAg assays in the overall and naive/on-treatment CHB patients. Additionally, we found that mean HBsAg levels resulting from the Architect assay were higher than those obtained by Elecsys assay.
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December 2016

Landmark reading alterations in patients with gastro-oesophageal reflux symptoms undergoing diagnostic gastroscopy.

Arab J Gastroenterol 2016 Dec 23;17(4):176-180. Epub 2016 Nov 23.

GATA Haydarpasa Training Hospital, Gastroenterology Department, 34668 Uskudar, Istanbul, Turkey. Electronic address:

Background And Study Aims: There is still a debate about the exact measurement of the oesophagogastric junction and the diaphragmatic hiatus among clinicians. The aim of this study was to investigate the differences between landmark readings of gastroscopy on intubation and extubation, and to correlate these readings with a gastro-oesophageal reflux questionnaire.

Patients And Methods: 116 cases who underwent diagnostic gastroscopy between January 2013 and June 2013 were included in this study. Landmark measurements were noted while withdrawing the endoscope and were also evaluated after the gastric air was fully emptied. We first used a frequency scale for the gastro-oesophageal reflux disease symptoms (FSSG) questionnaire in order to investigate dysmotility and acid reflux symptoms in the study population and correlated the FSSG questionnaire with intubation and extubation measurements at endoscopic examination.

Results: Mean age of included subjects was 49.41±17.7 (19-82) years. Males and females were equally represented. On FSSG scores, the total dysmotility score was 7.99±5.06 and the total score was 15.18±10.11. The difference between intubation and extubation measurements ranged from -3cm to +2cm (mean: -0.4). When an FSSG score of 30 was accepted as a cut-off value, we detected a significant difference between the measurements (p<0.05; t: 0.048).

Conclusion: Accuracy of landmark measurements during gastroscopy is clearly affected from insertion or withdrawal of the endoscope. When differences in measurements between insertion and withdrawal were evident, comparable with the FSSG scores, the results became significantly different. In conclusion, according to FSSG scores, these measurements should be performed at the end of the endoscopy.
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http://dx.doi.org/10.1016/j.ajg.2016.08.008DOI Listing
December 2016

Inefficacy of triple therapy and comparison of two different bismuth-containing quadruple regimens as a firstline treatment option for helicobacter pylori.

Saudi J Gastroenterol 2016 Sep-Oct;22(5):366-369

Department of Gastroenterology, GATA Haydarpasa Training Hospital, Istanbul, Turkey.

Background/aim: Increasing resistance of Helicobacter pylori to antimicrobials necessitated the development of new regimens and the modification of existing regimens. The present study aimed to compare the efficacy of two bismuth-containing quadruple regimens-one including clarithromycin (C) instead of metronidazole (M) and triple therapy.

Patients And Methods: Patients with H. pylori infection given the following regimens were sequentially enrolled in this retrospective study: (1) Triple therapy: Lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and amoxicillin 1 g b.i.d., (2) bismuth group C: Lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d., and bismuth subsalicylate 524 mg b.i.d., and (3) bismuth group M: Lansoprazole 30 mg b.i.d., amoxicillin 1 g b.i.d., metronidazole 500 mg t.i.d., and bismuth subsalicylate 524 mg b.i.d. for 14 days. Gastroscopy and 14 C-urea breath test were performed before enrollment, and urea breath test was repeated four weeks after the treatment.

Results: At per-protocol analysis, the eradication rates were 64.7% (95% confidence interval 60.4-68.7) with the triple therapy (n = 504), 95.4% (95% confidence interval 91.5-99.4) with the bismuth group C (n = 501), and 93.9% (95% confidence interval 89.7-98.7) with the bismuth group M (n = 505). The eradication rates were similar between the two bismuth groups (P > 0.05) but significantly greater than that of the triple therapy (P < 0.05).

Conclusion: In our study, both of the bismuth-containing quadruple therapies reached high eradication rates, whereas triple therapy was shown to be ineffective. Moreover, clarithromycin may also be a component of bismuth-containing quadruple therapy.
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http://dx.doi.org/10.4103/1319-3767.191141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051220PMC
May 2017

RE: Liver Shear-Wave Velocity to Diagnose Hepatic Fibrosis in Patients with Chronic Viral Hepatitis B.

Korean J Radiol 2016 Sep-Oct;17(5):822. Epub 2016 Aug 23.

Department of Gastroenterology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul 34668, Turkey.

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http://dx.doi.org/10.3348/kjr.2016.17.5.822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007411PMC
January 2018

Plasma Thrombin-activatable Fibrinolysis Inhibitor Levels Correlate with the Disease Activity of Ulcerative Colitis.

Intern Med 2016 15;55(14):1831-6. Epub 2016 Jul 15.

Department of Gastroenterology, Canakkale State Hospital, Turkey.

Objective Patients with ulcerative colitis (UC) are at an increased risk for thromboembolic events, particularly in patients with extensive and active disease. To date, a few studies have been published on the role of thrombin-activatable fibrinolysis inhibitor (TAFI) in UC. However, there are no reports in the literature investigating the effect of UC treatment on plasma TAFI levels. Methods The plasma TAFI antigen levels were quantitatively determined using ELISA kits for 20 UC patients at activation and remission, along with 17 healthy controls. The association between the TAFI levels and inflammatory markers was assessed to determine UC activation. To predict and determine the activation of UC, the Truelove-Witts index and the endoscopic activation index (EAI) were used for each subject. Results The plasma TAFI levels were higher in UC patients at activation of the disease compared with the remission state and in healthy controls. Spearman's correlation analyses revealed that the WBC (r: 0.586, p<0.001), hsCRP (r: 0.593, p<0.001) and EAI (r: 0.721, p<0.001) were significantly correlated with the TAFI levels. The overall accuracy of TAFI in determining UC activation was 82.5% with a sensitivity, specificity, NPV and PPV of 80%, 85%, 81% and 84.2%, respectively (cut-off value: 156.2% and AUC: 0.879). Conclusion The present study demonstrates that the TAFI levels are elevated in the active state of UC. The assessment of TAFI levels in patients with UC in conjunction with other markers of inflammation may provide additional information for estimating UC activation and severity.
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http://dx.doi.org/10.2169/internalmedicine.55.6473DOI Listing
March 2017

Immunohistochemical activity of Prohibitin-2 and Stomatin-Like Protein-2 in patients with ulcerative colitis.

Turk J Gastroenterol 2016 May 28;27(3):233-8. Epub 2016 Apr 28.

Department of Gastroenterology, Gülhane Military Medical Academy Haydarpaşa Training and Research Hospital, İstanbul, Turkey.

Background/aims: We aimed to semi-quantitatively investigate prohibitin-2 (Phb-2) and stomatin-like protein-2 (Slp-2) expressions in patients with ulcerative colitis (UC) and healthy controls using the immunohistochemical (IHC) method. We also aimed to evaluate the correlations between the activity of UC and the expressions of these two proteins.

Materials And Methods: Ninety-five patients with UC (82 males and 13 females) and 38 healthy controls (35 males and 3 females) were included. Clinical and endoscopic activities of UC were assessed. Conventional laboratory activation parameters and severity of inflammation measures were used for the evaluation of histological activity. IHC staining of biopsy samples for the two proteins were semi-quantitatively applied, similar to previously described methods for colon adenocarcinomas.

Results: IHC scores of Phb-2 were lower but Slp-2 scores were higher in the UC group than in the healthy controls (p<0.05 and p=0.003, respectively). Phb-2 scores were positively correlated with clinical and histological activities (r=0.364, p<0.05 and r=0.220, p<0.032, respectively). In the UC group, endoscopic activity scores, C-reactive protein levels, and sedimentation rates were also positively correlated with Phb-2 scores (r=0.279, p<0.05, r=0.216, p<0.05, and r=0.216, p<0.05, respectively). IHC scores of Slp-2 were not significantly correlated with the activity parameters of UC. However, there was a significant positive correlation between the expressions of Phb-2 and Slp-2 proteins (p<0.001).

Conclusion: Phb-2 may serve as a valuable new biomarker for predicting the severity of all UC activity parameters. The therapeutic effectiveness of both Phb-2 and Slp-2 should be taken into consideration.
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http://dx.doi.org/10.5152/tjg.2016.15460DOI Listing
May 2016

Mean platelet volume and red cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in patients with chronic hepatitis C.

Eur J Gastroenterol Hepatol 2016 Jul;28(7):744-8

aVan Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Van Departments of bGastroenterology cInfectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul dGulhane Military Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.

Objective: We designed this study to investigate the relationship between the severity of fibrosis and mean platelet volume (MPV), red cell distribution width, and red cell distribution width to platelet ratio (RPR) in patients with chronic hepatitis C (CHC).

Design: Overall, 98 biopsy-proven naïve CHC cases were enrolled in the study. Complete blood count variables, including white blood cell, hemoglobin, platelet count, MPV, red cell distribution width, platelet distribution width as well as aspartate transaminase, alanine transaminase, total bilirubin, albumin, and other routine biochemical parameters, were tested. Liver biopsy samples were assessed according to the Ishak scoring system. Data analyses were carried out using SPSS-15 software. Statistical significance was set at a P-value of less than 0.05.

Results: Of the 98 cases, 80 (81.6%) were men and 18 (18.4%) were women. Fibrosis scores of 69 cases (70.4%) (group 1) were less than 3, whereas 29 cases had fibrosis scores at least 3 (29.6%) (group 2). Significant differences in MPV and RPR were observed between these two groups (MPV: 8.19±1.002 vs. 8.63±0.67 fl, P<0.05; RPR: 0.0526±0.02 vs. 0.0726±0.02, P=0.001). The areas under the curve of the RPR and MPV for predicting significant fibrosis were 0.705 and 0.670, which was superior to the aspartate transaminase-to-alanine transaminase ratio and aspartate transaminase-to-platelet ratio index scores of the study group. Cut-off values were calculated for diagnostic performance, and the cut-off values for MPV and RPR were 8.5 and 0.07 fl, respectively.

Conclusion: MPV and RPR values were significantly higher in patients with CHC, associated with severity, and can be used to predict advanced histological liver damage. The use of MPV and RPR may reduce the need for liver biopsy. Further studies are required to determine the relationship between these parameters and the severity of fibrosis in hepatitis C patients.
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http://dx.doi.org/10.1097/MEG.0000000000000647DOI Listing
July 2016

Liver fatty acid-binding protein may be a useful marker for non-alcoholic fatty liver disease but obesity is a major concern.

Wien Klin Wochenschr 2016 Apr 1;128(7-8):304. Epub 2016 Feb 1.

Department of Gastroenterology, Canakkale State Hospital, Canakkale, Turkey.

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http://dx.doi.org/10.1007/s00508-016-0951-7DOI Listing
April 2016