Araştırma Çıktıları
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Item Six-year distribution pattern of hepatitis C virus in Turkey: a multicentre study(TAYLOR \& FRANCIS LTD, 2016-01-01) Altindis, Mustafa; Dal, Tuba; Akyar, Isin; Karatuna, Onur; Gokahmetoglu, Selma; Ulger, Seda Tezcan; Kulah, Canan; Uzun, Berrin; Sener, Asli Gamze; Ozdemir, Mehmet; Aydogan, Sibel; Kuskucu, Mert Ahmet; Midilli, Kenan; Otlu, Baris; Celen, Mustafa Kemal; Buruk, Kurtulus; Guducuoglu, HuseyinHepatitis C infection is a public health problem. The aim of this retrospective study was to determine the distribution of hepatitis C virus (HCV) genotypes in seven regions of Turkey, by evaluating 7002 patients with chronic HCV in a six-year period. During the 2009-2014 period, serum/plasma samples from 7002 new consecutive HCV RNA positive patients were collected. The female patients were 3867 (55.2\%). The genotype distribution of HCV patiens was evaluated by ages and years. Statistical analysis was performed by using the Mann-Whitney test and the chi(2) analysis. During the six-year period, genotype 1b was the most common genotype (67.7\%) followed by untypeable genotype 1 (7.7\%), genotype 4 (7.3\%) and genotype 3 (6.7\%). In 2014, genotype 3 was the second most common one (11.3\%) and genotype 4 was the third most common one (9.8\%). In the group with <25 years old patients, genotype 1b was most common (78.48\%, 62/79) between the years of 2009 and 2011, whereas genotype 3 (34.8\%, 86/247), between the years of 2012 and 2014. Genotype 1b was the most common in the groups between 26 and 35 years, 36 and 45 years, 46 and 55 years, 56 and 65 years. The rate of genotype 3 was increased from 4.78\% to 10.06\% and the rate of genotype 4 was increased from 1.3\% to 3.84\%, from 2009-2011 to 2012-2014. In recent years, genotypes 3 and 4 have gained importance. New therapeutic strategies and survey studies may be required for the modified HCV genotype pattern.Item A micro-elimination approach to addressing hepatitis C in Turkey(BMC, 2020-01-01) Idilman, Ramazan; Razavi, Homie; Robbins-Scott, Sarah; Akarca, Ulus Salih; Ormeci, Necati; Kaymakoglu, Sabahattin; Aygen, Bilgehan; Tozun, Nurdan; Guner, Rahmet; Bodur, Hurrem; Lazarus, Jeffrey V.Background In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. Methods Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in TurkeyItem ABSTRACT Are Family Physicians and Medical Students Aware of Chronic Hepatitis C Infection?(BILIMSEL TIP YAYINEVI, 2022-01-01) Nazli, Arzu; Sertcelik, Ahmet; Kahraman, Hasip; Erdem, Huseyin Aytac; Mermer, Sinan; Caglayan, Derya; Kivrak, Esra Erdem; Tasbakan, Meltem IsikgozIntroduction: Chronic hepatitis C is a public health problem that can result in cirrhosis, liver cancer, and death, which can be cured with current treatments. In our study, we evaluated the level of knowledge and awareness of medical school students and family physicians about chronic hepatitis C.Materials and Methods: Our study was carried out between 01.06.2022 and 01.08.2022, between the 1st and 6th grade medical students, family physicians (family medicine residents, family medicine specialists) using an online questionnaire.Results: In our study, 536 medical faculty students and 162 family physicians were recruited. Two hundred seventy one (50.6\%) of the students were male and the median age was 23.0 (2.0) years. Of the family physicians, 84 (51.2\%) were male, the median age was 30 (24-68) years and the median time in the profession was 14.5 (1-40) years. Students answered 69.2\% of the questions correctly, and family physicians answered 73\% correctly. While the students knew the transmission routes of hepatitis C mostly (97.2\%), they got the less information about the testing (34.9\%) and treatment (21.9\%). Family physicians answered the questions about the transmission routes of hepatitis C with a high rate (99.4\%), and the questions about the groups that should be tested (28\%) and the questions about the treatment of hepatitis C less correctly (29.4\%). In the multivariate analysis, the factors affecting the median knowledge score of the students were male gender (p= 0.019), the student's class (p= 0.002), having Infectious diseases and clinical microbiology committee (p= 0.005) and gastroenterology committee (p= 0.027). The only factor affecting the median knowledge score of family physicians was the use of online presentations by experts in their fields as a source of information (p= 0.003). 67\% of the students and 87.2\% of the family physicians answered the question ``How do you manage the person when the anti-HCV screening test is positive? `` as ``I will refer the patient to the infectious diseases and clinical microbiology or gastroenterology ``.Conclusion: In our study, it was found that awareness of screening and treatment was low in both groups. Considering that the main factors related to the level of knowledge of medical students are having committee of the gastroenterology and infectious diseases and clinical microbiology, and online presentations of experienced teachers in family physicians, preparing a special content for these groups may be useful in raising awareness and level of knowledge.Item An Evaluation of Chronic Hepatitis C Patients' Responses to Direct-Acting Antivirals According to Transient Elastography and Serum Biomarkers(GALENOS YAYINCILIK, 2022-01-01) Aydin, Nurten Nur; Koksal, IftiharObjectives: In this study, it was evaluated the changes in liver stiffness measurements measured by AST to Platelet Ratio index (APRI), Fibrosis 4 index (FIB-4), Age Platelet index (API), AST-ALT ratio (AAR) and transient elastography (TE) among the non-invasive fibrosis scores in chronic hepatitis C (CHC) patients treated with direct-acting agents (DM) and the effect of treatment. Materials and Methods: Ombitasvir-paritaprevir-ritonavir-dasabuvir +/- ribavirin (RBV) or sofosbuvir +/- ledipasvir (SOF +/- LDV) +/- RBV was given to the patients. Fibrosis scores were calculated with the biochemical data of the patients before the treatment, at the 4s . week of the treatment, at the end of treatment and at the sustained virological response 12 (SVR12) Liver stiffness measurements were recorded before treatment with TE and in SVR12. Post-treatment SVR12 responses were evaluated. Results: SVR12 was achieved in 97.9\% of 95 patients included in the study. Significant regression was found in APRI and FIB-4 scores, which are among the 4 serum fibrosis markers calculated in all patients (p<0.001, p<0.001). Liver stiffness was measured using TE in 75 patients. It was determined that the liver stiffness measurement (9.3 +/- 6.5 kPa) in SVR12 significantly decreased compared to the baseline (11.6 +/- 7.8 kPa) (p<0.001). Conclusion: DAA provides improvement in fibrosis scores and persistent viral response in patients. In our study, in which fibrosis was evaluated non-invasive methods, it was observed that there was a significant improvement in liver fibrosis with APRI, FIB-4 and TE measurements.Item Hepatitis C virus positive patient diagnosed after detection of atypical cryoglobulin(BAISHIDENG PUBLISHING GROUP INC, 2016-01-01) Ongen, Belkiz; Aksungar, Fehime Benli; Cicek, Bahattin; Akyar, Isin; Coskun, Abdurrahman; Serteser, Mustafa; Unsal, IbrahimA 60-year-old male patient presented with jaundice and dark urine for three days, icteric sclerae and skin rash on his legs for six months. Laboratory inves-tigations revealed an atypical cryoglobulinemia with high hepatitis C virus (HCV)-RNA levels. Imaging studies showed cholestasis was accompanying HCV. Capillary zone electrophoresis using immunosubtraction method revealed a polyclonal immunoglobulin G and immunoglobulin A (IgA) monoclonal cryoglobulin and that IgA lambda was absent in immu-nofixation electrophoresis. After a liver biopsy, chronic hepatitis C, HCV related mixed cryoglobulinemia and cryoglobulinemic vasculitis were diagnosed and antiviral therapy was initiated. Our HCV patient presented with cryoglobulinemic symptoms with an atypical cryoglobulinemia that was detected by an alternative method: Immunosubtraction by capillary electrophoresis. Different types of cryoglobulins may therefore have a correlation with clinical symptoms and prognosis. Therefore, the accurate immunotyping of cryoglobulins with alternative methods may provide more information about cryoglobulin-generated pathology.Item New treatments for chronic hepatitis C infection(MARMARA UNIV, FAC MEDICINE, 2016-01-01) Yapali, Suna; Tozun, NurdanThe goal of HCV treatment is to prevent cirrhosis, hepatocellular carcinoma, liver-related deaths. The development of direct-acting antiviral (DAA) agents which target various steps in HCV lifecycle led to a revolution by providing nearly complete eradication of HCV. The new treatment regimens with high cure rates have changed the standards of care in the regions where patients have access to new treatments. This review addresses the recent updates in management of chronic hepatitis C infection.