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Öğe Are noninvasive biochemical parameters an alternative to liver biopsy in patients with chronic hepatitis B?(2021) Konur, Sevki; Surmeli, Neslihan; Ozkahraman, Adnan; Dertli, Ramazan; Kayar, YusufAim: Although there is a gold standard liver biopsy in showing the histological activity of the disease, there are contradictory results in the studies conducted for using some non-invasive methods that are alternatively biochemically calculated due to being an invasive procedure. We aimed to investigate the relationship of FIB-4, APRI, API and AAR values with histopathology in patients undergoing liver biopsy due to chronic hepatitis B virus (HBV) infection. Materials and Method: Patients with follow-up between November/2016-October/2019 with the diagnosis of chronic HBV were included. Demographic data and histopathological data were documented. Accompanying comorbid diseases, medications and previous operations were questioned. Patients were grouped as mild, moderate and advanced fibrosis according to fibrosis scoring. Sensitivity, specificity, cutt-of, AUC values of biochemical parameters were calculated between the groups. Results: A total of 151 patients, 64(42.3%) women, were included in the study. As a result of the liver biopsy; mild fibrosis was found in 73(48.3%) patients, moderate fibrosis in 33(21.8%) patients and advanced fibrosis in 45(29.9%) patients. There was a significant correlation between fibrosis level and age, liver function tests, bilirubin and albumin (p<0.05). While there was no relationship between fibrosis stage and HBV-DNA, there was a significant relationship between groups with AAR, API, APRI and FIB4 (p<0.05). Conclusions: Although FIB-4, APRI, AAR and API values are important in determining the level of hepatic fibrosis, the effect of biochemical parameters on various factors negatively affects the specificity and sensitivity of these tests. For this reason, liver biopsy is still seen as the gold standard.Öğe Bariatric surgery may exacerbate hyperbilirubinemia in patients with Gilbert s Syndrome(2017) Asil, Mehmet; Dertli, Ramazan; Biyik, Murat; Ataseven, Hüseyin; Polat, Hakki; Demir, AliÖğe Bariatric surgery may exacerbate hyperbilirubinemia in patients with Gilbert's Syndrome(2017) Asil, Mehmet; Dertli, Ramazan; Bıyık, Murat; Ataseven, Hüseyin; Polat, Hakkı; Demir, AliÖğe Duodenal Varices Diagnosed By Endoscopic Ultrasound: A Case Report(2017) Asil, Mehmet; Dertli, Ramazan; Biyik, Murat; Ataseven, Hüseyin; Polat, Hakki; Demir, AliÖğe The effect of gluten-free diet on mean platelet volume, neutrophil and neutrophil/lymphocyte ratio in children with celiac disease(2020) Agin, Mehmet; Kayar, Yusuf; Dertli, Ramazan; Konur, Sevki; Surmeli, Neslihan; Ozkahraman, AdnanAim: Celiac Disease (CD) is a chronic, autoimmune and systemic disease. In the present study, the purpose was to investigate the effect of a gluten-free diet on Mean-Platelet-Volume (MPV), neutrophil and neutrophil/lymphocyte Ratio (NLR).Material and Methods: A total of 106 patients who were diagnosed with CD and who were followed-up by the Pediatric Gastroenterology Clinic of the Hospital, and 50 healthy children were included in the study. The demographic data of the patients and the neutrophil, lymphocyte, platelet, NLR were recorded before the diagnosis and one-year after gluten-free diet. The hematologic parameters of the patients were compared with the healthy control group at the diagnosis time. Following a one-year gluten-free diet, the hematologic parameters of the patients were compared with the parameters at the diagnosis time.Results: The mean age of the patients was 12.1±3.2 years (7-16 years), and the mean age of the control group was 14.5±4.1 years (12-16 years). A total of 48% (51/106) of the patients were female and 34% (17/50) of the control group was female. Hematological parameters of patients compared pre-dietary and post-dietary; lymphocyte and platelet ratios were significantly higher, whereas neutrophils, MPV and NLR were significantly lower. Neutropenia was detected in 15 patients before the diet. It was observed that neutrophil level reached the normal range after gluten-free diet in patients with neutropenia.Conclusions: The MPV, neutrophil and NLR values, that was low during the diagnosis, may be ameliorative with the gluten-free diet. In addition, CD should be considered in the differential diagnosis of neutropenic patients.Öğe Effects of Lycium barbarum on bacterial translocation in thioacetamide induced liver injury in rats(European Journal of Inflammation, 2015) Bilgiç, Yılmaz; Harputluoğlu, Murat; Kutlu, O; Demirel, Ulvi; Gül, Mehmet; Otlu, Barış; Temel, İsmail; Gürsoy, S.; Dertli, Ramazan; Selçuk, Engin Burak; Yılmaz, İsmet; Kilis, TubaBackground and study aim: The aim of the present study was to investigate the effects of Lycium barbarum (LB) on bacterial translocation (BT) frequency in thioacetamide (TAA)-induced liver injury in rats. Materials and methods: Group 1 was the control. In group 2 (TAA), rats received TAA daily for 3 days. In group 3 (TAA+LB), Lycium barbarum was administered orally 25 mg/kg for 21 days prior to the first TAA injection. In group 4 (LB), rats received only Lycium barbarum. Results: In our study, Lycium barbarum treatment did not attenuate liver damage. Lycium barbarum treatment decreased ileal E. coli counts and intestinal damage but it did not alter BT frequency. Conclusions: In conclusion, the effects of Lycium barbarum on BT may be related to ongoing severe liver damage in this model.Öğe Factors affecting hepatitis B immunization in celiac disease(2019) Kayar, Yusuf; Dertli, RamazanAim: While 90-95% of the adult population responds to hepatitis-B vaccination, it is known that, this rate is lower in patients with CD. In our study, determination of response rates of vaccinated celiac patients, and the affecting factors associated with vaccine responses were the aims of our investigation. Material and Methods: The study included 280 celiac patients who applied to the polyclinic between 2015-2019 years. Demographic, anthropometric characteristics (age, gender, onset age, disease duration, smoking, body mass index(BMI), waist-hip ratios) and symptoms in patients were documented. Hepatitis B, C, delta serology were examined. The prevalence of chronic hepatitis and associated risk factors were evaluated. Hepatitis-B vaccination rates and vaccine responses were determined. The risk factors associated with the immune response were reviewed. Results: 212 (75.7%) of the patients were female, the mean-age of the patients was 33.4±10.8 and the disease duration was 4.9±3.7 years. In 14 (5%) of the patients there were chronic viral infections, 18 (6.4%) had natural immunity, 92 (32.9%) were immunized, 58 (56.4%) were not encountered with viral infection. No significant correlation was found between the presence of chronic viral hepatitis and risk factors. 28 (30.4%) patients who had not vaccine response. It was observed that; the dietary incompatibility and absence of immunological remission were significantly higher, the BMI and the waist size were significantly lower in non-response group (P0.05). Conclusions: Considering the mild-high prevalence of chronic viral infection in celiac patients, it is important to vaccinate these patients against infections. It is of great importance to implement re-vaccination protocol in the patients without vaccine response.Keywords: Celiac disease; hepatitis B; vaccination.Öğe Is neutrophil/lymphocyte and platelet/lymphocyte ratio a predictive factor for the fibrous stage in patients with chronic hepatitis B?(2021) Konur, Sevki; Surmeli, Neslihan; Ozkahraman, Adnan; Dertli, Ramazan; Kayar, YusufAim: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are an inexpensive inflammatory marker that can be easily obtained from the blood count and can be used in many chronic diseases. In our study, we aimed to investigate the relationship between fibrosis stage and NLR, PLR in patients with chronic hepatitis B virus (HBV). Materials and Methods: 173 patients with chronic HBV were included in the study. The demographic data and hemogram parameters of all patients were recorded. Histopathological data of the patients were documented. Accompanying comorbid diseases, medications and previous operations were questioned. In chronic HBV patients, fibrosis level was compared with hematological parameters. Results: A total of 173 patients, 100 (57.8%) of whom were male, were included in the study. As a result of the liver biopsy; mild fibrosis (steage/1-2) in 83(47.9%) patients, moderate fibrosis (steage/3-4) in 35(20.3%) patients and advanced fibrosis (stage/5-6) in 55(31.8%) patients. In advanced fibrosis group, liver function tests and bilirubin levels were significantly higher and albumin level was significantly lower (p<0.05). It was found that NLR level was significantly higher in moderate fibrosis than mild fibrosis, and PLR level was significantly lower in the advanced fibrosis group than in the mild and moderate fibrosis groups (p<0.05). Conclusions: We showed that there is a significant relationship between fibrosis level and NLR, PLR. However, with the available data, it does not seem possible to say that noninvasive methods can completely replace invasive procedures such as liver biopsy. Prospectively designed studies with larger patient participation are needed.Öğe Larazotide acetate reduces the frequency of bacterial translocation in the thioacetamide-induced liver failure in rats(Elsevier, 2020) Caliskan, Ali Riza; Harputluoglu, Muhsin Murat; Otlu, Baris; Gul, Mehmet; Ozerol, Elif; Uremis, Nuray; Dertli, Ramazan[Abstract Not Available]Öğe Neutrophil to lymphocyte ratio is increased in chronic helicobacter pylori infection and returns to normal after successful eradication(Turgut Özal Tıp Merkezi Dergisi, 2016) Asil, Mehmet; Dertli, RamazanAbstract Aim: Neutrophil to lymphocyte ratio (NLR) is a useful, low cost marker and it was studied in several diseases. This study was conducted to investigate NLR in chronic Helicobacter pylori infection. Materials and Methods: Clinic and laboratory data of 286 patients with chronic Helicobacter pylori infection and 130 Helicobacter pylori negative controls were analyzed retrospectively. Results: Mean neutrophil to lymphocyte ratio was higher in Helicobacter pylori (+) group than Helicobacter pylori (-) controls (1.98±0.76 vs. 1.64±0.44, p<0.001 respectively) Mean white blood cell and neutrophil counts were also significantly higher in Helicobacter pylori (+) group than Helicobacter pylori (-) controls (7.28±1.55/μL vs. 6.90±1.38 /μL, p=0.011 and 4.27±1.17 /μL vs. 3.82±1.04 /μL, p<0.001 respectively). Lymphocyte count, Hb, Hct, RDW, Plt, MPV, PDW were similar in both groups. 253 patients (88.5%) were given Helicobacter pylori eradication regimen. Post-treatment data were available in 76 (26.6%) patients. Helicobacter pylori, eradication treatment was successful in 45 (59.2%) patients (Group 1) and unsuccessful in 31 (40.8%) patients (Group 2). In group 1, mean pretreatment and post-treatment NLR were 1.99±0.75 and 1.70±0.60 respectively and difference was statistically significant (p=0,004). In group 2 mean pretreatment and post-treatment NLR were 1.93±0.59 and 1.76±0.56 respectively but the difference was not statistically significant (p=0.11). Conclusion: NLR is increased in chronic H.pylori infection and returns to normal after successful H.pylori eradication treatment. Keywords: Neutrophil To Lymphocyte Ratio; Helicobacter Pylori, disease eradication.Öğe Neutrophil to lymphocyte ratio is increased in chronic helicobacter pylori infection and returns to normal after successful eradication(Turgut Özal Tıp Merkezi Dergisi, 2016) Asıl, Mehmet; Dertli, RamazanAbstract Aim: Neutrophil to lymphocyte ratio (NLR) is a useful, low cost marker and it was studied in several diseases. This study was conducted to investigate NLR in chronic Helicobacter pylori infection. Materials and Methods: Clinic and laboratory data of 286 patients with chronic Helicobacter pylori infection and 130 Helicobacter pylori negative controls were analyzed retrospectively. Results: Mean neutrophil to lymphocyte ratio was higher in Helicobacter pylori (+) group than Helicobacter pylori (-) controls (1.98±0.76 vs. 1.64±0.44, p<0.001 respectively) Mean white blood cell and neutrophil counts were also significantly higher in Helicobacter pylori (+) group than Helicobacter pylori (-) controls (7.28±1.55/μL vs. 6.90±1.38 /μL, p=0.011 and 4.27±1.17 /μL vs. 3.82±1.04 /μL, p<0.001 respectively). Lymphocyte count, Hb, Hct, RDW, Plt, MPV, PDW were similar in both groups. 253 patients (88.5%) were given Helicobacter pylori eradication regimen. Post-treatment data were available in 76 (26.6%) patients. Helicobacter pylori, eradication treatment was successful in 45 (59.2%) patients (Group 1) and unsuccessful in 31 (40.8%) patients (Group 2). In group 1, mean pretreatment and post-treatment NLR were 1.99±0.75 and 1.70±0.60 respectively and difference was statistically significant (p=0,004). In group 2 mean pretreatment and post-treatment NLR were 1.93±0.59 and 1.76±0.56 respectively but the difference was not statistically significant (p=0.11). Conclusion: NLR is increased in chronic H.pylori infection and returns to normal after successful H.pylori eradication treatment. Keywords: Neutrophil To Lymphocyte Ratio; Helicobacter Pylori, disease eradication.Öğe NOD2 Risk Variants and Pathological Bacterial Translocation in Decompensated Cirrhosis Reply(Springer, 2016) Harputluoglu, Murat M. M.; Bilgic, Yilmaz; Erdogan, Mehmet Ali; Atayan, Yahya; Cagin, Yasir Furkan; Dertli, Ramazan; Otlu, Baris[Abstract Not Available]Öğe Nucleotide binding oligomerization domain containing protein 2 Variants in patients with spontaneous bacterial peritonitis(Digestive Diseases and Sciences, 2016) Harputoğlu, Muhsin Murat Muhip; Dertli, Ramazan; Otlu, Barış; Demirel, UIvi; Yener, Özkan; Bilgiç, Yılmaz; Erdoğan, Mehmet Ali; Atayan, Yahya; Çağın, Yasir FurkanBackground The occurrence of spontaneous bacterial peritonitis (SBP) is significantly increased in carriers of nucleotide-binding oligomerization domain-containing protein 2 (NOD2) variants, suggesting that local immune alterations might be implicated in bacterial translocation (BT). Aims We aimed to assess the role of the NOD2 gene in conferring susceptibility to SBP. We also sought to determine whether levels of serum interleukin-6 (IL-6), lipopolysaccharide-binding protein, and soluble TNF-a receptor, along with the presence of bacterial DNA (bactDNA) in ascitic fluid, are appropriate markers for BT in patients with liver cirrhosis and SBP. Methods A cohort of 171 patients was divided into two groups: patients with SBP (n = 82) and those without SBP (n = 89). The presence of the most common NOD2 variants (p.R702W, p.G908R, and c.3020insC) was determined in these patients. Results We detected the p.G908R variant in four patients (4.9 %) of the SBP group. No significant difference was observed between the SBP and non-SBP groups for NOD2 risk variants. The frequency of bactDNA in ascitic fluid was higher for patients with NOD2 variants than for patients without variants (p = 0.021). Serum IL-6 levels in the SBP group were higher than those in the non-SBP group. Conclusions The frequent detection of bactDNA in ascites of patients with the p.G908R variant suggests there is a strong association between NOD2 risk variants and BT in SBP patients. In addition, increased serum IL-6 levels and bactDNA in ascitic fluid could be considered surrogate markers for BT in patients with cirrhosis.Öğe Nucleotide-Binding Oligomerization Domain-Containing Protein 2 Variants in Patients with Spontaneous Bacterial Peritonitis(Springer, 2016) Harputluoglu, Murat M. M.; Dertli, Ramazan; Otlu, Baris; Demirel, Ulvi; Yener, Ozkan; Bilgic, Yilmaz; Erdogan, Mehmet AliThe occurrence of spontaneous bacterial peritonitis (SBP) is significantly increased in carriers of nucleotide-binding oligomerization domain-containing protein 2 (NOD2) variants, suggesting that local immune alterations might be implicated in bacterial translocation (BT). We aimed to assess the role of the NOD2 gene in conferring susceptibility to SBP. We also sought to determine whether levels of serum interleukin-6 (IL-6), lipopolysaccharide-binding protein, and soluble TNF-alpha receptor, along with the presence of bacterial DNA (bactDNA) in ascitic fluid, are appropriate markers for BT in patients with liver cirrhosis and SBP. A cohort of 171 patients was divided into two groups: patients with SBP (n = 82) and those without SBP (n = 89). The presence of the most common NOD2 variants (p.R702W, p.G908R, and c.3020insC) was determined in these patients. We detected the p.G908R variant in four patients (4.9 %) of the SBP group. No significant difference was observed between the SBP and non-SBP groups for NOD2 risk variants. The frequency of bactDNA in ascitic fluid was higher for patients with NOD2 variants than for patients without variants (p = 0.021). Serum IL-6 levels in the SBP group were higher than those in the non-SBP group. The frequent detection of bactDNA in ascites of patients with the p.G908R variant suggests there is a strong association between NOD2 risk variants and BT in SBP patients. In addition, increased serum IL-6 levels and bactDNA in ascitic fluid could be considered surrogate markers for BT in patients with cirrhosis.Öğe The relation between life quality and subtype of the disease in patients with irritable bowel syndrome(2019) Kayar, Yusuf; Agin, Mehmet; Unver, Nurcan; Dertli, Ramazan; Kirpinar, IsmetAim: Irritable bowel syndrome (IBS) is not a life-threatening condition; however, people with IBS have a low quality of life (QOL) that might affect their education, social and professional achievements. Many studies have shown that patients who have IBS have lower QOL compared to the general population together with patients who have chronic diseases. The relation between IBS subtype and QOL is still not clear. For this reason, our study aims to evaluate the relationship between subtypes of the disease and QOL in patients who have IBS. Material and Methods: The 100 patients with IBS and 100 healthy individuals who were aged from 18 to 65 years, were included in our study. The relationship between disease subtype and quality of life in IBS patients were analyzed. Results: Regarding quality of life between the groups in the examination; the overall health scores were lower at a significant level in the patients who had IBS subtype as predominant-constipation than those who had IBS subtypes as predominant-diarrhea and mixed type (p=0.013;p=0.045;p<0.05,respectively).The vitality scores were higher at a significant level in patients whose IBS subtypes were predominant-diarrhea than those who had the IBS subtype as predominant-constipation (p=0.007;p<0.01). There were no statistically significant differences between the IBS subtypes and other parameters(p>0.05). Conclusion: It was shown that the QOL of IBS patients were significantly lower than the healthy population, but some differences were also found between the disease subtypes. QOL measurement as part of future therapeutic trials in IBS will help ensure optimal treatment.Öğe Serum soluble TWEAK levels in non-alcoholic fatty liver disease(2019) Asil, Mehmet; Demir, Ali; Unver, Nurcan; Polat, Hakki; Ataseven, Huseyin; Uysal, Saliha; Kayar, Yusuf; Keskin, Muharrem; Yolacan, Ramazan; Biyik, Murat; Dertli, RamazanAim: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The exact pathogenesis of NAFLD has not been fully elucidated. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a member of TNF superfamily and it has been implicated in the pathogenesis of several diseases including liver inflammation and fibrosis. Current study was conducted to evaluate serum sTWEAK levels in patients with NAFLD.Material and Methods: Seventeen patients with biopsy proven non-alcoholic steatohepatitis (NASH), 22 patients with simple hepatosteatosis and 30 healthy controls were included in the study and serum sTWEAK concentrations were measured using commercial ELISA kits.Results: Mean serum sTWEAK concentration was significantly lower in the NASH group when compared to the simple hepatosteatosis group and healthy controls (199.6±101.2 pg/mL, 246.1±65.7 pg/mL and 277.6±117.6 pg/mL respectively, p=0.029). ROC analyses for sTWEAK to differentiate NASH patients from healthy controls and from simple hepatosteatosis revealed that AUC for sTWEAK was 0.712 (%95 CI, 0.543-0.880). For the specified cut off value, 171.1 pg/mL positive and negative predictive values calculated were 64.3% and 85.5% respectively. Conclusion: Serum sTWEAK concentration is decreasedin patients with NASH when compared to patients with simple hepatosteatosis and healthy controls. Keywords: Nonalcoholic steatohepatitis; tumor necrosis factor-like weak inducer of apoptosis; sTWEAK; fibroblast growth factor-inducible 14; Fn 14.Öğe Sirozlu hastalarda spontan bakteriyal peritonit ile NOD2 gen mutasyonu ve bakteriyal translokasyon arasındaki ilişki(İnönü Üniversitesi, 2013) Dertli, RamazanBakteriyel translokasyon (BT) spontan bakteriyal peritonitin (SBP) gelişiminde önemli bir rol oynamaktadır. Son yıllarda yapılan çalışmalarda karaciğer sirozunda SBP?nin nucleotide-binding oligomerization domain containing 2 (NOD2) gen aleli ve BT sıklığıyla ilişkili olduğu bildirilmiştir. Biz bu çalışmada asitli sirotik hastalarda spontan bakteriyal peritonit ile BT ve NOD2 varyantı arasındaki ilişkiyi araştırmayı amaçladık. Çalışmamıza etyoloji ayırt etmeksizin sirotik asit gelişmiş SBP?si olan 82 hasta ve SBP?si olmayan 89 hasta dahil edildi. Çalışmamızda BT ilişkili olduğu düşünülen 3 NOD2 gen aleli (p.R702W, p.G908R, c.3020insC) çalışıldı. BT varlığını saptamak için tüm hastalarda asit sıvısında bakteriyal DNA ve serumda İnterlökin-6(IL-6), tümör nekrosis faktör reseptörü(TNF-R) ve lipoprotein binding protein (LPB) bakıldı. SBP olan hastalarda asit sıvısında bakteriyal DNA varlığı SBP olmayan hastalardan anlamlı şekilde farklıydı. SBP ve SBP olmayan hastalar arasında NOD2 gen varyant sıklığı açısından anlamlı farklılık saptanmadı. Kültür pozitif SBP?li hastalarda NOD2 gen varyant sıklığı kültür negatif hastalardan anlamlı şekilde farklıydı. NOD2 gen varyantı olan hastalarda asit sıvısında bakteriyel DNA sıklığı, NOD2 gen varyantı olmayan hastalara göre istatistiksel olarak anlamlı şekilde farklı saptandı. Bu çalışmada bulgularımız asit kültürü ve bakterial DNA pozitifliği ile NOD2 gen mutasyonu arasında anlamlı bir ilişki bulunduğunu düşündürmektedir.
