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    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, Yusuf
    Aim: 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.
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    Comparison of platelet count and mean platelet volume values before and after treatment in rheumatoid arthritis and ankylosing spondylitis patients receiving tumor necrosis factor alpha inhibitor therapy
    (2021) Konur, Sevki; Demirtunc, Refik
    Aim: In our study, we planned to reveal the change of the mean platelet volume (MPV) with anti-TNF treatment given in patients with Rheumatoid-Arthritis (RA) and Ankylosing-Spondylitis (AS) and to evaluate the clinical importance of MPV in the follow-up of these diseases.Materials and Methods: Patients who applied to our hospital's between 2011 and 2013 were included in the study. 40 patients participated in the study. The average ages of the patients were 43.8±9.9 years (range:25-68 years). All patients were examined retrospectively, Hemoglobin (Hb), Hematocrit (Hct), Platelet count, Mean Red-Blood-Cell Volume (MCV), MPV, Erythrocyte-Sedimentation-Rate (ESR), C-Reactive Protein (CRP) before anti-TNF treatment were recorded. Then, the same values were checked six months after the treatment. Averages of the Hb, Hct, MCV, PLT, MPV, CRP, ESH parameters of patients before and after treatment were compared with each other.Results: When the values before and after the treatment were compared, there was a significant decrease in ESR (p:0.002). There was also a statistically significant increase in Hb and Hct values after treatment (p:0.002, p:0.039, respectively). A significant decrease was observed in mean platelet count and MPV values after treatment (p:0.001). Although there was an increase in the MCV value, it was not statistically significant. Likewise, there was a decrease in CRP value but it was not statistically significant.Conclusion: In this study, it was concluded that the MPV value and platelet count could be inexpensive biomarkers in the follow-up of RA and AS. However, more controlled prospective studies are needed in this regard.
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    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, Adnan
    Aim: 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.
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    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, Yusuf
    Aim: 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.
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    Relationship between hepatosteatosis and histopathological and biochemical paramaters in patients with noncirrhotic chronic hepatitis B
    (2021) Konur, Sevki
    Aim: Fatty liver is a common liver disease in the community. Mitochondrial dysfunction and oxidative process cause insulin resistance, causing fatty liver. Fatty liver diseases are higher in patients infected with chronic hepatitis B virus (HBV) than the normal population. We aimed to investigate the relationship between hepatosteatosis and biochemical and histopathological parameters in chronic HBV patients. Materials and Methods: Patients with follow-up between September/2017-November/2019 with chronic HBV diagnosis were included. Demographic and histopathological data of all patients were documented. Comorbid diseases, medications and previous operations were questioned. The presence of steatosis was determined by ultrasonography (USG) to all patients. Biochemical and histopathological data were compared with the presence of steatosis. Results: A total of 94 patients, 50(53.1%) women were included in the study. As a result of liver biopsy; while 20(21.2%) patients had no fibrosis (steage 0), 74(78.8%) patients had fibrosis (steage 1-3). In USG, 45(47.8%) patients were found to have hepatosteatosis and 49(52.2%) patients were not. In the comparison between the groups; there was no significant relationship between sex, age, liver function tests, HBV-DNA level, hepatic activity index and hepatosteatosis (p>0.05). A significant relation was found between the presence of fibrosis and hepatosteatosis (p=0.021). Conclusions: Chronic HBV is an inflammatory process that ends with cirrhosis and hepatocellular carcinoma, and in this process, fatty liver may increase disease and cause disease progression. In this context, it is important to prevent the development of steatosis in chronic HBV patients. However, this should be supported in prospective studies in larger populations.