Browsing by Author "Suna, Nuretdin"

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ACUTE NECROTIZING PANCREATITIS AFTER TRANSARTERIAL CHEMOEMBOLIZATION IN A PATIENT WITH HEPATOCELLULAR CANCER: CASE REPORT AND REVIEW OF THE LITERATURE
(2019) Ocal, Serkan; Suna, Nuretdin; Etik, Digdem Ozer; Bovyat, Fatih; Selcuk, Haldun; 31574073
Acute Pancreatitis Caused by Primary Pancreatic Lymphoma in A Geriatric Patient with Sarcoidosis: Report of A Complex Case
(2017) Ozer Etik, Digdem; Suna, Nuretdin; Tepeoglu, Merih; Coskun, Mehmet; Selcuk, Haldun; 0000-0002-4724-0728; 0000-0001-6234-7788; 0000-0002-9894-8005; 0000-0001-5630-022X; 0000-0002-8445-6413; AAJ-4707-2021; AAI-8822-2021; AAK-5222-2021; AAM-4120-2021; AAJ-6976-2021
The purpose of reporting this case is to raise the awareness of the rapid worsening clinical presentation of acute pancreatitis in an older patient, unexpected encounter with pancreatic lymphoma, and sarcoidosis-lymphoma syndrome. An 80-year-old woman was diagnosed with sarcoidosis 16 years ago. Following recent hospitalization because of acute pancreatitis, non-obstructive and non-invasive pancreatic mass was found on radiological images. Histopathology confirmed the mass to be diffuse large B-cell lymphoma. We report this case because of its complicated the etiology of acute pancreatitis in an older patient, presentation of pancreatic lymphoma, and immune pathogenesis of sarcoidosis-lymphoma syndrome.
Can a 1-day clear liquid diet with a split - dose polyethylene glycol overcome conventional practice patterns during the preparation for screening colonoscopy?
(2019) Etik, Digdem Ozer; Suna, Nuretdin; Gunduz, Cemre; Bostan, Ahmet; Ozdemir, Alperen; Gurel, Bade Yagmur; Yenisekerci, Ezgi; Boyacioglu, Ahmet Sedat; 31258137
Background/Aims: A successful screening colonoscopy is closely linked to the quality of a bowel preparation. In this study, we aimed to determine the impact of a 1-day clear liquid diet (CLD) compared to a 3-day combined diet (CMD) accompanied by a split-dose regimen of polyethylene glycol and electrolyte lavage solution (PEG-ELS) for screening colonoscopy. Materials and Methods: This was a prospective, randomized, endoscopist-blinded study. Patients referred for screening colonoscopy were randomized to four groups as a 1-day CLD+PEG-ELS vs. a 1-day CLD+sulfate free (SF)-PEG-ELS and a 3-day CMD+PEG-ELS vs. a 3-day CMD+SF-PEG-ELS. An assessment of the quality of colon cleaning, tolerability to the preparation, and symptoms related to the preparation were recorded. Results: A total of 506 patients were enrolled in this study. The quality of bowel preparation was significantly inferior in the CMD+PEG-ELS group than CLD+PEG-ELS (p=0.004) and CMD+SF-PEG-ELS groups (p=0.007). There were no statistical differences among the groups in terms of the polyp detection rate. With respect to an easy rating of diet following and the consumption of laxative, there were no significant differences among the four groups. Gastric fullness and nausea/vomiting were pointed out much more, especially in the SF-PEG-ELS users (p=0.008 and p=0.004, respectively). Conclusion: A 1-day CLD was not inferior to a 3-day CMD for colonoscopy preparation in terms of bowel cleaning, the polyp detection rate, and patient tolerance.
Can the treatment duration be shortened in bismuth-containing therapies for Helicobacter pylori eradication?
(2019) Etik, Digdem Ozer; Sezer, Semih; Suna, Nuretdin; Oztas, Erkin; Kilic, Zeki Mesut Yalin; 31258136
Background/Aims: The duration of Helicobacter pylori (H. pylori) eradication therapy as a range (e.g., 10-14 days) is an ignored problem. There is no any particular treatment duration described in current guidelines, and the conditions for when to use 10-day therapy vs. 14-day therapy have not been elucidated. The aim of this study is to determine an effective and reliable H. pylori treatment duration in clinical practice. There were four different treatment modalities administered to groups, and success rates were compared. Materials and Methods: Patients were eligible to participate in the study if they had a biopsy-proven H. pylori infection. Each patient was randomly assigned to one of the four treatment groups according to a predetermined sequence: 14-day or 10-day bismuth-containing quadruple therapy (BQT) groups and 14-day or 10-day moxifloxacin-bismuth-combined treatment (MBCT) groups. Results: A total of 216 patients (54 per group) were enrolled. Two-hundred six patients (95.3%) completed therapy. There was no significant difference in the eradication rates between those patients who received 10- and 14-days BQT regimens (p=0.67). The 14-BQT protocol had the highest eradication rate, the MBCT regimes had the highest compliance, and the 10-MBCT protocol had the poorest results for H. pylori eradication. The posttreatment questionnaire on adverse effects identified nausea/vomiting as the most common side effect (35.7%). Conclusion: Overall, the results of our study suggest that shortening the BQT protocol duration to 10 days does not weaken the H. pylori eradication rate. Moreover, quinolone-containing therapies with the lowest eradication rate among the groups should not be offered as a salvage treatment in case of the BQT failure.
Effect of Propranolol Treatment on the Incidence of Hepatocellular Carcinoma in Patients Waiting for Liver Transplant With Cirrhosis: A Retrospective, Surveillance Study in a Tertiary Center
(2019) Suna, Nuretdin; Etik, Digdem Ozer; Ocal, Serkan; Selcuk, Haldun; 31050621
Objectives: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver and the third most common cause of all cancer-related mortalities. There is a need to develop new strategies to prevent hepatocellular carcinoma, as the incidence of this cancer continues to increase despite all advancements. In this study, our aim was to determine the effects of propranolol treatment on the incidence of hepatocellular carcinoma in cirrhotic patients waiting for liver transplant. Materials and Methods: We retrospectively reviewed the data of patients waiting for liver transplant with cirrhosis due to various causes registered at the Hepatocellular Carcinoma Surveillance Program between June 2011 and December 2017 in our center. These data were compared between patients using propranolol and those not using propranolol. Results: Of the 231 patients, 135 (58.4%) were male and 96 (41.6%) were female. The mean age was 58.1 +/- 14 years. We noted that 153 of total patients (66.2%) were using propranolol. Three patients (2%) were using 20 mg propranolol, 125 (81.7%) were using 40 mg propranolol, 10 (6.5%) were using 60 mg propranolol, and 15 (9.8%) were using 80 mg propranolol. Of total patients, 36 (15.6%) developed hepatocellular carcinoma, including in 12 patients (7.8%) using propranolol and 24 patients (30.8%) who did not use this agent (P < .001).Thus, the hepatocellular carcinoma frequency was 5.22 times lower in patients receiving propranolol than in those not receiving propranolol. Conclusions: Although causes of cirrhosis and initial stages were similar in both groups using and not using propranolol, incidence of hepatocellular carcinoma was significantly lower in the propranolol group than in the group without propranolol. This result showed that propranolol treatment has a protective effect for hepatocellular carcinoma in patients waiting for liver transplant with cirrhosis.
Efficacy and Tolerability of Direct-Acting Antiviral Agents for Hepatitis C Virus Infection in Kidney Transplant Recipients
(2018) Suna, Nuretdin; Etik, Digdem Ozer; Ocal, Serkan; Selcuk, Haldun; Dagli, Ulku; Hilmioglu, Fatih; Boyacioglu, Sedat; Haberal, Mehmet; https://orcid.org/0000-0001-6234-7788; https://orcid.org/0000-0003-3719-9482; https://orcid.org/0000-0002-8445-6413; https://orcid.org/0000-0002-6440-5686; https://orcid.org/0000-0002-9370-1126; https://orcid.org/0000-0002-3462-7632; AAI-8822-2021; ABH-4817-2020; AAJ-6976-2021; AAJ-4437-2021; AAE-7637-2021; AAJ-8097-2021
Efficacy of Abatacept Treatment in A Patient with Enteropathy Carrying A Variant of Unsignificance in CTLA4 Gene: A Case Report
(2023) Musabak, Ugur; Erdogan, Tuba; Ceylaner, Serdar; Ozbek, Emre; Suna, Nuretdin; Ozdemir, Binnaz Handan; 37731560; KBC-3218-2024
BACKGROUNDCytotoxic T Lymphocyte Antigen-4 (CTLA4) deficiency is a genetic defect that causes a common variable immunodeficiency (CVID) clinical phenotype. Several studies have reported an association between CTLA mutations or variants and various autoimmune diseases. Targeted therapy models, which have become increasingly popular in recent years, have been successful in treating CTLA4 deficiency. In this article, we discuss the clinical outcomes of abatacept treatment in a patient with CTLA4 and lipopolysaccharide-responsive beige-like anchor (LRBA) variants that was previously diagnosed with CVID.CASE SUMMARYA 25-year-old female patient, who was visibly cachectic, visited our clinic over the course of five years, complaining of diarrhea. The patient was diagnosed with ulcerative colitis in the centers she had visited previously, and various treatments were administered; however, clinical improvement could not be achieved. Severe hypokalemia was detected during an examination. Her serum immunoglobulin levels, CD19+ B-cell percentage, and CD4/CD8 ratio were low. An endoscopic examination revealed erosive gastritis, nodular duodenitis, and pancolitis. Histopathological findings supported the presence of immune mediated enteropathy. When the patient was examined carefully, she was diagnosed with CVID, and intravenous immunoglobulin treatment was initiated. Peroral and rectal therapeutic drugs including steroid therapy episodes were administered to treat the immune mediated enteropathy. Strict follow-ups and treatment were performed due to the hypokalemia. After conducting genetic analyses, the CTLA4 and LRBA variants were identified and abatacept treatment was initiated. With targeted therapy, the patient's clinical and laboratory findings rapidly regressed, and there was an increase in weight.CONCLUSIONThe heterozygous CTLA4 variant identified in the patient has been previously shown to be associated with various autoimmune diseases. The successful clinical outcome of abatacept treatment in this patient supports the idea that this variant plays a role in the immunopathogenesis of the disease. In the presence of severe disease, abatacept therapy should be considered until further testing can be conducted.
Extraordinary biliary variant
(2017) Suna, Nuretdin; Etik, Digdem Ozer; Ocal, Serkan; Selcuk, Haldun; Hilmioglu, Fatih; Boyacioglu, Sedat; 0000-0003-3719-9482; 0000-0002-9370-1126; 0000-0002-6440-5686; 0000-0002-4724-0728; 0000-0002-8445-6413; 0000-0001-6234-7788; 28336501; ABH-4817-2020; AAE-7637-2021; AAJ-4437-2021; AAJ-4707-2021; AAJ-6976-2021; AAI-8822-2021
Hepatocellular Carcinoma with Cardiac Cirrhosis After the Fontan Procedure
(2018) Suna, Nuretdin; Etik, Digdem Ozer; Ocal, Serkan; Hilmioglu, Fatih; 0000-0001-6234-7788; 0000-0002-4724-0728; 0000-0002-6440-5686; 0000-0003-3719-9482; 29373356; AAI-8822-2021; AAJ-4707-2021; AAJ-4437-2021; ABH-4817-2020
Kolesistektomi materyallerinde saptanan safra kesesi poliplerinin kolorektal polip histopatolojisi ve lokalizasyonu ile ilişkisinin değerlendirilmesi
(Başkent Üniversitesi Tıp Fakültesi, 2022) Tek, Korhan; Suna, Nuretdin
Amaç: Kolorektal kanser (KRK), dünyada en yaygın görülen üçüncü; kansere bağlı mortalite açısından ise ikinci sırada yer alan önemli bir sağlık sorunudur. KRK’lerin çoğu adenomatöz poliplerden yıllar içinde gelişmektedir. İleri histolojik özellikler, polip boyutu ve polip sayısının adenomatöz poliplerin maligniteye dönüşümünde önemli risk faktörleri olduğu bilinmektedir. Kolorektal adenomun erken saptanması ve çıkarılması KRK ile ilişkili mortaliteyi azaltır. Bu nedenle kolorektal adenomlarla ilişkili risk faktörlerinin belirlenmesi, kanserlerin taranmasını ve önlenmesini kolaylaştırabilir. Safra kesesi polipleri sıklıkla rutin abdominal ultrasonografi sırasında teşhis edilir ve çoğu neoplastik olmayan kolesterol polipleridir. Safra kesesi polipleri aynı zamanda kolorektal adenom için de yaygın risk faktörleri olan obezite, glukoz intoleransı, metabolik sendrom ve artmış beden kitle indeksi ile ilişkilendirilmiştir. Bununla birlikte, safra kesesi polipleri ile kolorektal prekanseröz lezyonlar arasındaki ilişki belirsizliğini korumaktadır. Bu çalışmada, kolesistektomi materyallerinde saptanan safra kesesi poliplerinin kolorektal poliplerin sayısı, boyutu, yerleşim yeri ve histopatolojik özellikleri ile ilişkisinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Çalışmamızda Başkent Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı Endoskopi Ünitesi’nde 01.01.2012-10.03.2022 tarihleri arasında farklı endikasyonlarla kolonoskopi yapılmış ve kolonoskopi öncesi ya da sonrası iki yıl içinde farklı safra kesesi hastalıkları nedeniyle açık veya laparoskopik kolesistektomi prosedürü uygulanmış hastalara ait veriler retrospektif olarak incelenmiştir. Çalışmamıza dahil edilen 762 erişkin hastada demografik veriler, komorbiditeler, kolorektal poliplerin endoskopik ve histopatolojik özellikleri ile kolesistektomi materyallerinin patolojik sonuçları analiz edildi. Kolorektal poliplerin karakteristik özellikleri, safra kesesi polipleri olan ve olmayan hastalar arasında karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 56,49±8,77 (29-78) olup olguların %52,9’u (n=403) kadındı. Hastaların %47’sinde (n=358) safra kesesinde polip ve %57’sinde (n=434) kolorektal polip saptandı. Kolorektal polipli hastaların %32,3’ünde (n=140) neoplastik olmayan polip(ler), %64’ünde (n=278) en az bir neoplastik (adenomatöz ve/veya SSA/P) polip ve %3,7’sinde (n=16) kolorektal karsinom saptandı. Safra kesesi polipli hastaların %96,1’inde (n=344) benign neoplastik olmayan, %2,8’inde (n=10) benign neoplastik ve %1,1’inde (n=4) malign polip saptandı. Safra kesesinde polip bulunan hastaların %62’sinde (n=222) ve bulunmayan hastaların %52,4’ünde (n=212) herhangi bir histolojik tipte kolorektal polip bulundu ve istatistiksel açıdan anlamlı fark saptandı (p değeri=0,011). Ayrıca safra kesesinde polip bulunan hastaların %45,8’inde (n=164) ve safra kesesinde polip bulunmayan hastaların %32,2’sinde (n=130) kolorektal adenom veya invaziv karsinom saptandı (p değeri=0,005). Safra kesesinde polip bulunan ve bulunmayan kolorektal polipli hastaların yaş ortalaması sırasıyla 57,17±7,6 ve 58,59±8,26 olarak bulundu (p değeri=0,025). Kolorektal neoplastik polip sayı ortalaması safra kesesinde neoplastik polip bulunanlarda 3,00±1,18 ve safra kesesinde polip bulunmayanlarda 2,20±1,29 olarak saptandı (p değeri=0,017). Safra kesesinde neoplastik polipi olanlarda neoplastik olmayan polipi olanlara göre, kolorektal neoplastik poliplerin hem sayı ortalaması (3,00±1,18’e karşı 2,16±1,41; p değeri=0,014) hem de çoklu (≥2) olması (%90,9’a karşı %56,2; p değeri=0,027) arasında anlamlı fark saptandı. Safra kesesinde adenomyomatöz hiperplazi bulunan hastalarda safra kesesinde polip bulunmayan hastalara göre ileri adenomatöz polip varlığı açısından anlamlı fark saptandı (%69’a karşı %33,8; p değeri=0,001). Sonuç: Çalışmamızın, kolesistektomi materyallerinde saptanan safra kesesi polipleri ile kolorektal polip karakteristikleri arasındaki ilişkiyi araştıran ilk çalışma olması ile literatüre önemli katkılar sağladığı açıktır. Bu çalışmada safra kesesinde polip bulunanlarda bulunmayanlara göre, safra kesesindeki polipin histolojik tipinden bağımsız olarak, kolorektal neoplastik polip sıklığının artmış olduğu bulundu. Aynı zamanda safra kesesinde polip bulunmayanlara göre; safra kesesinde neoplastik polip bulunanlarda kolorektal neoplastik polip sayı ortalamasının artmış olması ve adenomyomatöz hiperplazi bulunanlarda kolorektal neoplastik poliplerin ileri histolojik değişiklikler göstermesi açısından da anlamlı sonuçlar saptandı. Sonuç olarak; safra kesesi polipleri ile kolorektal neoplastik polipler arasındaki ilişki ortaya konduğu için kolorektal kanser tarama programlarında safra kesesi polipleri de dikkate alınmalıdır. Aim: Colorectal cancer (CRC), the third most common cancer in the world and the second in terms of cancer-related mortality, is a major health problem. Most CRCs develop from adenomatous polyps over the years. Advanced histological features, polyp size, and polyp count are factors known to increase the risk of adenomatous polyps’ transformation into a malignancy. Early detection and removal of colorectal adenoma may decrease colorectal cancer related mortality. Therefore, identification of risk factors associated with colorectal adenomas may facilitate screening and prevention of colorectal cancers. Gallbladder polyps are frequently diagnosed on routine abdominal ultrasonography and most of are non-neoplastic cholesterol polyps. The risk of gallbladder polyps has been linked to obesity, glucose intolerance, metabolic syndrome, and an increased body mass index, which are also common risk factors for colorectal adenoma. However, the relationship between gallbladder polyps and colorectal precancerous lesions remains elusive. In the present study aimed to evaluate the relationship between gallbladder polyps detected in cholecystectomy materials with the number, size, localization and histopathological features of colorectal polyps. Material and Method: In our study, the data of patients is retrospectively examined who underwent colonoscopy for different indications between 01.01.2012 and 10.03.2022 in the Baskent University Faculty of Medicine Gastroenterology Department Endoscopy Unit and underwent open or laparoscopic cholecystectomy procedure for different gallbladder diseases within the two years before or after colonoscopy. Demographic data, comorbidities, endoscopic and histopathological characteristics of colorectal polyps and pathological results of cholecystectomy materials were analyzed for 762 adult patients who included in our study. The characteristics features of colorectal polyps were compared between patients with or without gallbladder polyps. Results: The mean age of the patients were 56.49±8.77 (29-78) and 52.9% (n=403) of the patients were female. Gallbladder polyps were detected in 47% (n=358) and colorectal polyps were detected in 57% (n=434) of the patients. Among the patients with colorectal polyps, non-neoplastic polyp(s) were detected in 32.3% (n=140), at least one neoplastic (adenomatous and/or SSA/P) polyp in 64% (n=278), and colorectal carcinoma in 3.7% (n=16). Among the patients with gallbladder polyps, benign non-neoplastic polyps were detected in 96.1% (n=344), benign neoplastic polyps in 2.8% (n=10) and malignant polyps in 1.1% (n=4). Colorectal polyps of any histological type were found in 62% (n=222) of the patients with polyps in the gallbladder and in 52.4% (n=212) of the patients without them, and a statistically significant difference was found (p value=0.011). In addition, colorectal adenoma or invasive carcinoma were detected in 45.8% (n=164) of the patients with polyps in the gallbladder and in 32.2% (n=130) of the patients without polyps in the gallbladder (p value=0.005). The mean age of the patients with colorectal polyps with and without gallbladder polyps was 57.17±7.6 and 58.59±8.26, respectively (p value=0.025). The mean number of colorectal neoplastic polyps was 3.00±1.18 in patients with neoplastic polyps in the gallbladder and 2.20±1.29 in those without polyps in the gallbladder (p value=0.017). In those with neoplastic polyps in the gallbladder, there was a significant difference between both mean number of colorectal neoplastic polyps (3.00±1.18 vs. 2.16±1.41, p value=0.014) and multiple (≥2) of colorectal neoplastic polyps (90.9% vs. 56.2%, p value=0.027) compared to those with non-neoplastic polyps in the gallbladder. There was a significant difference in the presence of advanced adenomatous polyps in patients with adenomyomatous hyperplasia in the gallbladder compared to patients without gallbladder polyps (69% vs. 33.8%, p value=0.001). Conclusion: It is clear that our study makes important contributions to the literature as it is the first study to investigate the relationship between gallbladder polyps detected in cholecystectomy materials and colorectal polyp characteristics. In this study, the frequency of colorectal neoplastic polyps was found to be increased in patients with gallbladder polyps compared to those without gallbladder polyps, regardless of the histological type of gallbladder polyp. At the same time according to those who do not have polyps in the gallbladder significant results were also found in terms of the increased mean number of colorectal neoplastic polyps in patients with neoplastic polyps in the gallbladder and advanced histological changes in colorectal neoplastic polyps in patients with adenomyomatous hyperplasia. As a result, the relationship between gallbladder polyps and colorectal neoplastic polyps has been demonstrated, gallbladder polyps should also be considered in colorectal cancer screening programs.
Pleural Effusion in Acute Pancreatitis, Not Always Related
(2017) Suna, Nuretdin; Oztas, Erkin; Kuzu, Ufuk Baris; Kayacetin, Ertugrul; Aydog, Gulden; Koksal, Aydin Seref; https://orcid.org/0000-0001-6234-7788; AAI-8822-2021
Relationship between Helicobacter pylori infection and white matter lesions in patients with migraine
(2022) Ocal, Serkan; Ocal, Ruhsen; Suna, Nuretdin; 35597897
Background/aim White matter lesions (WML) are more frequently observed in migraine patients than in the average population. Associations between Helicobacter pylori (H. pylori) infection and different extraintestinal pathologies have been identified. Here, we aimed to investigate the association between H. pylori infection and WML in patients diagnosed with episodic migraine. Materials and methods A retrospective study was conducted with 526 subjects with a diagnosis of episodic migraine. Hyperintensity of WML had been previously evaluated in these patients with brain magnetic resonance imaging (MRI) examinations. Previous endoscopic gastric biopsy histopathological examination of the same patients and reports on H. pylori findings were recorded. The demographic characteristics of the patients, such as age, gender and chronic systemic diseases such as hypertension and diabetes mellitus (DM) were recorded. Statistical evaluation was made. Results Evaluation was made among 526 migraine patients who met the inclusion criteria, comprising 397 (75.5%) females and 129 (24.5%) males with a mean age of 45.57 +/- 13.46 years (range, 18-69 years). WML was detected on brain MRI in 178 (33.8%) patients who were also positive for H. pylori (p < 0.05). Subjects who are H. pylori-positive with migraine, WML were observed at a 2.5-fold higher incidence on brain MRI (odds ratio: 2.562, 95% CI 1.784-3.680). WML was found to be more significant in patients with hypertension and migraine than those without (p < 0.001). Older age was also found to be associated with WML (OR = 1.07, 95% CI: 0.01-0.04, p < 0.001). The age (p < 0.001), H. pylori (p < 0.001), hypertension (p < 0.001), and hypertension + DM (p < 0.05), had significant associations in predicting WML according to the multivariate logistic regression analysis. The presence of hypertension had a higher odds ratio value than the other variables. Conclusion It was concluded that H. pylori infection, as a chronic infection, can be considered a risk factor in developing WML in subjects with migraine.
Successful Treatment With Direct-Acting Antiviral Agents of Hepatitis C in Patients With End-Stage Renal Disease and Kidney Transplant Recipients
(2019) Etik, Digdem Ozer; Suna, Nuretdin; Ocal, Serkan; Selcuk, Haldun; Dagli, Ulku; Colak, Turan; Hilmioglu, Fatih; Boyacioglu, Ahmet Sedat; Haberal, Mehmet; 0000-0003-3719-9482; 0000-0003-0664-0976; 0000-0002-9370-1126; 30719954; ABH-4817-2020; AAE-7637-2021; S-4068-2018
Objectives: The introduction of direct-acting antiviral agents has allowed significant chances for treatment for difficult-to-treat populations. This study aimed to investigate the efficacy, tolerability, and safety of these therapies in both patients with end-stage renal disease and kidney transplant recipients with chronic hepatitis C virus infection. Materials and Methods: This study was a retrospective analysis with prospective follow-up of patients. The antiviral combination of ombitasvir 25 mg, paritaprevir 75 mg, ritonavir 50 mg, and dasabuvir 50 mg was prescribed to patients with end-stage renal disease or kidney transplant recipients with noncirrhotic or compensated cirrhotic liver disease. The other antiviral combination consisted of sofosbuvir 400 mg and ledipasvir 90 mg, which was recommended to patients with decompensated cirrhosis or those who could not tolerate the first combination regimen. Ribavirin was given to all patients with genotype 1a hepatitis C virus infection. All clinical and laboratory data were recorded at week 4, at end of the treatment, and at 12 weeks after completion of treatment. Results: In terms of efficacy, sustained virologic response at 12 weeks was achieved in 94% of patients in the end-stage renal disease group and 92% of patients in the kidney transplant group. In terms of tolerability, antiviral treatment was well tolerated in both groups. Cardiac arrest and cerebrovascular accident were seen in the end-stage renal disease group; severe mucositis and glossitis were seen in the kidney transplant group. Hospitalization was needed in 2 patients for treatment of drug interactions with tacrolimus and sirolimus. Renal allograft function worsened in 2 patients, with 1 patient having biopsyproven antibody-mediated rejection. Conclusions: We observed great efficacy and safety in both kidney transplant recipients and patients with end-stage renal disease with these agents in treatment of chronic hepatitis C. However, clinicians should remain aware of drug interactions and adverse events in this fragile patient population.
Successful Treatment with Direct-Acting Antiviral Agents of Hepatitis C in the Setting of End-Stage Renal Disease
(2018) Etik, Digdem Ozer; Suna, Nuretdin; Ocal, Serkan; Selcuk, Haldun; Dagli, Ulku; Colak, Turan; Hilmioglu, Fatih; Boyacioglu, Sedat; Haberal, Mehmet; 0000-0002-4724-0728; 0000-0001-6234-7788; 0000-0003-3719-9482; 0000-0002-8445-6413; 0000-0003-0664-0976; 0000-0002-8372-7840; 0000-0002-6440-5686; 0000-0002-9370-1126; 0000-0002-3462-7632; AAJ-4707-2021; AAI-8822-2021; ABH-4817-2020; AAJ-6976-2021; S-4068-2018; AAJ-8554-2021; AAJ-4437-2021; AAE-7637-2021; AAJ-8097-2021
When abdominal pain knocks the door: an unusual presentation of chronic lymphocytic leukemia
(2019) Etik, Digdem Ozer; Suna, Nuretdin; Borcek, Pelin; Hilmioglu, Fatih; 31198573
A 67-year-old man presented non-specific abdominal pain. Polypoid mass at appendiceal orifice in the cecum was found on endoscopic investigation without appendicitis sign. Histopathology elucidated underlying mucosal infiltration that was chronic lymphocytic leukemia. This is an isolated and unusual gastrointestinal involvement of hematologic disorder in an older patient.