Emrah Posul

Chronic hepatitis B associated with hepatic steatosis, insulin resistance, necroinflammation and fibrosis

BACKGROUND The effect of hepatitis B virus (HBV) infection on fatty liver disease is unclear. OBJECTIVES The aim of this study was to investigate the viral and host causes of fatty liver in chronic hepatitis B (CHB) patients. This study included 88 CHB patients of which 17 were not treated. Liver biopsy was performed in each patient. Group 1 included those with hepatic steatosis (n=28) and group 2 those without hepatic steatosis. The groups were compared in terms of age, body mass index (BMI), Homeostasis Model Assessment- Insulin Resistance (HOMA-IR), viral load, biochemical parameters and histological findings. Patients in group 1 were subdivided according to the degree of steatosis as follows: grade 1 (15 patients, 53.6%), grade 2 (6 patients, 21.4%), and grade 3 (7 patients, 25%). RESULTS In group 1 (n=28), mean age, BMI, cholesterol, and HOMA-IR were found to be significantly higher than in group 2 (n=60). There were no significant differences in the positivity of viral load, HbeAg, treatment, fibrosis and other laboratory parameters between the two groups. HOMA-IR was the only independent predictive factor of liver steatosis in patients with CHB in logistic regression analysis. CONCLUSION Hepatic steatosis in CHB patients was associated with host metabolic factors.

Epidemiologic features of ınflammatory bowel disease in Western Blacksea region of Turkey for the last 10 years: retrospective cohort study

Background/Aims There are only a few epidemiological study about inflammatory bowel disease in the last 10 years in Turkey, especially in Western Blacksea region. In our study, we aimed to identify the changes in the incidence and the prevalence of inflammatory bowel disease in Western Blacksea region at the last 10 years. Methods Totally 223 patients with inf lammatory bowel disease (160 ulcerative colitis, 63 Crohn’s disease) were enrolled in the study followed up between 2004 to 2013 years. The epidemiological characteristics of patients were recorded. Results The prevalences were 12.53/105 and 31.83/105 for Crohn’s disease and ulcerative colitis respectively. Mean annual incidences increased from 0.99/105 and 0.45/105 for ulcerative colitis and Crohn’s disease (2004 to 2005 years) to 4.87/105 and 2.09/105 for ulcerative colitis and Crohn’s disease respectively (2011 to 2013 years). While the prevalence was higher in urban areas in Crohn’s disease (12.60/105), it was higher in rural areas in ulcerative colitis (36.17/105). In ulcerative colitis, mean annual incidences were 2.91/105 and 2.86/105 for urban and rural areas respectively. In Crohn’s disease, they were 1.37/105 and 1.08/105 for urban and rural areas respectively. Conclusions The incidence of inflammatory bowel disease seems to increase in Western Blacksea region at the last 10 years. This increment is more prevalent in rural areas.

THYROID HEMATOMA: AN UNUSUAL COMPLICATION OF UPPER GASTROINTESTINAL ENDOSCOPY

Here, we present a case of a patient who developed thyroid hematoma after upper gastrointestinal (GI) endoscopy without premedication except oral lidocaine spray. A 38-year-old man was admitted to our hospital with epigastric pain for the past 1 month. Upper GI endoscopy revealed antral gastritis, a 7-mm ulcer in the apical and a 6-mm ulcer in the posterior wall of the duodenal bulb. Pantoprazole 40 mg was given once daily. Two days later, he presented with an acute swelling of his neck. On examination, a large, nonfluctuant thyroid swelling was seen on the right side of the neck. His blood pressure, temperature, pulse rate, and respiratory rate were normal. Blood tests showed normal hemoglobin, international normalized ratio, and thyroid function tests. Ultrasonography of the neck revealed a 23 × 37 × 44-mm expanding hematoma located at the right thyroid gland. Major complications related to diagnostic upper GI endoscopy are rare events and include cardiopulmonary adverse events, infection, perforation, and bleeding. The complication rate of upper GI endoscopy is between 0.1‰ and 5‰ ( Ben-Menachem et al., 2012 ). The risk of bleeding during diagnostic upper GI endoscopy is low. It is related to hemorrhagic

Kronik Hepatit B ve C’li Hastalarda Karaciğer Hastalığın Farklı Evrelerinde Yaşam Kalitesinin Değerlendirilmesi

Amac : Kronik hastaliklarda, hastalarin buyuk cogunlugu hastaligin getirdigi agri, yorgunluk ve depresif semptomlarla birlikte sosyal yasamlarinda kisitliliklar, fiziksel aktivitelerini gerceklestirmede guclukler yasamaktadir. Buna bagli yasam kalitesi etkilenmektedir. Kronik hepatitli hastalarda, hastaliginin erken evrelerinde hicbir semptom bulunmazken, ileri evrede siroza bagli komplikasyonlar yasam kalitesini belirgin sekilde bozabilir. Calismamizda farkli evrelerdeki kronik hepatit B (KHB) ve C (KHC)’li hastalarda yasam kalitesinin karsilastirilmasi planlanmistir. Gerec-Yontem : Hastaligin farkli evrelerindeki toplam 175 kronik hepatit (129 KHB ve 46 KHC) hastasi ve 20 saglikli gonullu calismaya alindi. Hastalara SF-36 yasam kalite indeksi anketi uygulandi. Bulgular: Her iki hastalik icin de SF-36’nin internal uyumlulugu yuksekti (Cronbach α KHB ve KHC icin:0.95, kontrol icin:0.90). KHB’de evre arttikca fiziksel ve sosyal fonksiyonlarda daha cok kisitlanma, canlilik ve enerjide daha fazla azalma ve sagliginin daha cok kotulesecegine inanma izlenmektedir. Genel olarak fiziksel ve mental saglik ile genel yasam kalitesi evre arttikca anlamli derecede azalmaktadir. KHC’de ise evre arttikca sadece fiziksel sagligin bozulmasindan dolayi iste ve gunluk etkinliklerde daha fazla kisitlama olmaktadir. Univaryant regresyon analizinde, tani ve hastalik evresinin yaninda yasadigi cevre, egitim seviyesi, sigara ve medeni durum yasam kalitesine etki eden faktorler olarak tespit edildi. Sonuc: KHC ve KHB’de, hastalik suresinin uzun olmasi, beraberinde komplikasyonlarin gelismesi ve psikolojik morbidite ile ozellikle KHC’de ve siroz hastalarinda tedavilerin yan etkileri hastalarda yasam kalitesini ciddi oranda dusurmektedir. Yasam kalitesinin arttirilmasi icin tedavi opsiyonlarinin hastaya gore olusturulmasi ve yasam kalitesini etkileyen diger faktorlerin saptanip en aza indirilmesi gerekmektedir. Anahtar Kelimeler: Kronik hepatit B; Kronik hepatit C; Yasam kalitesi

The Rates of Incidence and Prevalence of Inflamatory Bowel Diseases in Bolu/Düzce Region: Retrospective Cohort Study Between 2004-2013

Retrospective cohort study between 2004-2013 Güray Can, Emrah Poşul, Bülent Yılmaz, Hatice Can, Uğur Korkmaz, Fatih Ermiş, Mevlüt Kurt, Ülkü Dağlı 1 Abant İzzet Baysal Üniversitesi, Tıp Fakültesi, Gastroenteroloji Bilim Dalı, Bolu 2 Bolu İzzet Baysal Devlet Hastanesi, Gastroenteroloji Bölümü, Bolu 3 Abant İzzet Baysal Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Bolu 4 Düzce Üniversitesi, Tıp Fakültesi, Gastroenteroloji Bilim Dalı, Düzce 5 Başkent Üniversitesi, Tıp Fakültesi, Gastroenteroloji Bilim Dalı, Ankara