Browsing by Author "Eren, Fatih"

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Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis
(Wiley, 2021-11-28) Efe, Cumali; Lammert, Craig; Taşcılar, Koray; Dhanasekaran, Renumathy; Ebik, Berat; Higuera-de la Tijera, Fatima; Çalışkan, Ali R.; Peralta, Mirta; Gerussi, Alessio; Massoumi, Hatef; Catana, Andreea M.; Purnak, Tuğrul; Rigamonti, Cristina; Aldana, Andres J. G.; Khakoo, Nidah; Nazal, Leyla; Frager, Shalom; Demir, Nurhan; Irak, Kader; Melekoğlu-Ellik, Zeynep; Kaçmaz, Hüseyin; Balaban, Yasemin; Atay, Kadri; Eren, Fatih; Alvares-da-Silva, Mario R.; Cristoferi, Laura; Urzua, Alvaro; Eskazan, Tuğçe; Magro, Bianca; Snijders, Romee; Barutcu, Sezgin; Lytvyak, Ellina; Zazueta, Godolfino M.; Demirezer-Bolat, Aylin; Aydın, Mesut; Heurgue-Berlot, Alexandra; De Martin, Eleonora; Ekin, Nazım; Yıldırım, Sümeyra; Yavuz, Ahmet; Bıyık, Murat; Narro, Graciela C.; Kıyıcı, Murat; Akyıldız, Murat; Kahramanoğlu-Aksoy, Evrim; Vincent, Maria; Carr, Rotonya M.; Günşar, Fulya; Reyes, Eira C.; Harputluoğlu, Murat; Aloman, Costica; Gatselis, Nikolaos K.; Ustundağ, Yücel; Brahm, Javier; Vargas, Nataly C. E.; Güzelbulut, Fatih; Garcia, Sandro R.; Aguirre, Jonathan; Anders, Margarita; Ratusnu, Natalia; Hatemi, İbrahim; Mendizabal, Manuel; Floreani, Annarosa; Fagiuoli, Stefano; Silva, Marcelo; Idılman, Ramazan; Satapathy, Sanjaya K.; Silveira, Marina; Drenth, Joost P. H.; Dalekos, George N.; Assis, David N.; Bjornsson, Einar; Boyer, James L.; Yoshida, Eric M.; Invernizzi, Pietro; Levy, Cynthia; Montano-Loza, Aldo J.; Schiano, Thomas D.; Ridruejo, Ezequiel; Wahlin, Staffan; KIYICI, MURAT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; FHW-0015-2022
Background We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.
Extrahepatic autoimmune diseases in primary biliary cholangitis: Prevalence and significance for clinical presentation and disease outcome
(Wiley, 2020-08-13) Eren, Fatih; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; CPU-6796-2022; 12545949900
Background and Aim The prevalence and clinical significance of extrahepatic autoimmune diseases (EHAIDs) have not been evaluated in a large cohort of primary biliary cholangitis (PBC). Methods The medical records of 1554 patients with PBC from 20 international centers were retrospectively reviewed. Development of decompensated cirrhosis (ascites, variceal bleeding, and/or hepatic encephalopathy) and hepatocellular carcinoma were considered clinical endpoints. Results A total of 35 different EHAIDs were diagnosed in 440 (28.3%) patients with PBC. Patients with EHAIDs were more often female (92.5%vs86.1%,P < 0.001) and seropositive for anti-mitochondrial antibodies (88%vs84%,P = 0.05) and antinuclear antibodies and/or smooth muscle antibodies (53.8%vs43.6%,P = 0.005). At presentation, patients with EHAIDs had significantly lower levels of alkaline phosphatase (1.76vs1.98 x upper limit of normal [ULN],P = 0.006), aspartate aminotransferase (1.29vs1.50 x ULN,P < 0.001), and total bilirubin (0.53vs0.58 x ULN,P = 0.002). Patients with EHAIDs and without EHAIDs had similar rates of GLOBE high-risk status (12.3%vs16.1%,P = 0.07) and Paris II response (71.4%vs69.4%,P = 0.59). Overall, event-free survival was not different in patients with and without EHAIDs (90.8%vs90.7%,P = 0.53, log rank). Coexistence of each autoimmune thyroid diseases (10.6%), Sjogren disease (8.3%), systemic sclerosis (2.9%), rheumatoid arthritis (2.7%), systemic lupus erythematosus (1.7%), celiac disease (1.7%), psoriasis (1.5%), and inflammatory bowel diseases (1.3%) did not influence the outcome. Conclusions Our study confirms that EHAIDs are frequently diagnosed in patients with PBC. The presence of EHAIDs may influence the clinical phenotype of PBC at presentation but has no impact on PBC outcome.
SARS-CoV-2 vaccination and risk of severe COVID-19 outcomes in patients with autoimmune hepatitis
(Academic Press Ltd- Elsevier Science Ltd, 2022-10-01) Efe, Cumali; Tascilar, Koray; Gerussi, Alessio; Bolis, Francesca; Lammert, Craig; Ebik, Berat; Stattermayer, Albert Friedrich; Cengiz, Mustafa; Gokce, Dilara Turan; Cristoferi, Laura; Peralta, Mirta; Massoumi, Hatef; Montes, Pedro; Cerda, Eira; Rigamonti, Cristina; Yapali, Suna; Adali, Gupse; Caliskan, Ali Riza; Balaban, Yasemin; Eren, Fatih; Eskazan, Tugce; Barutcu, Sezgin; Lytvyak, Ellina; Zazueta, Godolfino Miranda; Kayhan, Meral Akdogan; Heurgue-Berlot, Alexandra; De Martin, Eleonora; Yavuz, Ahmet; Biyik, Murat; Narro, Graciela Castro; Duman, Serkan; Hernandez, Nelia; Gatselis, Nikolaos K.; Aguirre, Jonathan; Idilman, Ramazan; Silva, Marcelo; Mendizabal, Manuel; Atay, Kadri; Guzelbulut, Fatih; Dhanasekaran, Renumathy; Montano-Loza, Aldo J.; Dalekos, George N.; Ridruejo, Ezequiel; Invernizzi, Pietro; Wahlin, Staffan; EREN, FATİH; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; 0000-0003-2667-8963 ; JQJ-3328-2023
Background: Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine. Patients and methods: We performed a retrospective study on AIH patients with COVID-19. The outcomes of AIH patients who had acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection after at least one dose of COVID-19 vaccine were compared to unvaccinated patients with AIH. COVID-19 outcome was classified according to clinical state during the disease course as: (i) no hospitalization, (ii) hospitalization without oxygen supplementation, (iii) hospitalization with oxygen supplementation by nasal cannula or mask, (iv) intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v) ICU admission with invasive mechanical ventilation or (vi) death, and data was analyzed using ordinal logistic regression. Results: We included 413 (258 unvaccinated and 155 vaccinated) patients (81%, female) with a median age of 52 (range: 17-85) years at COVID-19 diagnosis. The rates of hospitalization were (36.4% vs. 14.2%), need for any supplemental oxygen (29.5% vs. 9%) and mortality (7% vs. 0.6%) in unvaccinated and vaccinated AIH patients with COVID-19. Having received at least one dose of SARS-CoV-2 vaccine was associated with a significantly lower risk of worse COVID-19 severity, after adjusting for age, sex, comorbidities and presence of cirrhosis (adjusted odds ratio [aOR] 0.18, 95% confidence interval [CI], 0.10-0.31). Overall, vaccination against SARSCoV-2 was associated with a significantly lower risk of mortality from COVID-19 (aOR 0.20, 95% CI 0.11-0.35). Conclusions: SARS-CoV-2 vaccination significantly reduced the risk of COVID-19 severity and mortality in patients with AIH.
Serum levels of osteoprotegerin in the spectrum of nonalcoholic fatty liver disease
(Taylor & Francis, 2010-12) Yılmaz, Yusuf; Yönal, Oya; Kurt, Ramazan; Eren, Fatih; Özdoğan, Osman Cavit; Çelikel, Çiğdem Ataizi; İmeryüz, Neşe; Kalaycı, Cem; Avşar, Erol; Oral, Arzu Yılmaztepe; Arı, Ferda; Korkmaz, Şeniz; Ulukaya, Engin; Uludağ Üniversitesi/Tıp Fakültesi/Biyokimya Anabilim Dalı.; Uludağ Üniversitesi/Fen-Edebiyat Fakültesi/Biyoloji Bölümü.; 0000-0002-6729-7908; AAG-7012-2021; 23091316500; 24376085300; 36666461900; 6602927353
Objective. Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily with pleiotropic effects on inflammation, endocrine function and the immune system. Reduced OPG levels are related to insulin resistance. We tested the hypothesis that serum levels of OPG may be associated with nonalcoholic fatty liver disease (NAFLD). Material and methods. Four groups of patients were enrolled in the present study: subjects with definite nonalcoholic steatohepatitis (NASH, n = 56), borderline NASH (n = 26), simple fatty liver (n = 17) and healthy controls without evidence of liver disease (n = 58). Serum levels of OPG were measured by ELISA. Results. Concentrations of OPG were significantly lower in patients with definite NASH (median: 45 pg/mL, p < 0.001) and borderline NASH (57 pg/mL, p < 0.001) than in controls (92 pg/mL). The area under the ROC curve for distinguishing between steatohepatitis (definite NASH plus borderline NASH) and healthy controls using OPG was 0.82. The use of a cut-off level < 74 pg/mL for serum OPG levels yielded sensitivity and specificity values of 75.6% and 75.9%, respectively. Conclusions. Serum osteoprotegerin concentrations are reduced in patients with the more severe forms of NAFLD and may serve as a noninvasive biomarker to identify patients with NASH.
Serum pigment epithelium-derived factor levels are increased in patients with biopsy-proven nonalcoholic fatty liver disease and independently associated with liver steatosis
(Elsevier, 2011-11-20) Yılmaz, Yusuf; Eren, Fatih; Çolak, Yaşar; Kurt, Ramazan; Şenateş, Ebubekir; Tuncer, İlyas; İmeryuz, Neşe; Ayyıldız, Talat; Dolar, Enver; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; AAG-9177-2021; 6603155277; 6602075084
Background: Increased serum concentrations of pigment epithelium-derived factor (PEDF) have been linked to the metabolic syndrome in the general population. However, the relationship between serum PEDF and nonalcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, remains unknown. Methods: We assayed serum PEDF levels in 156 patients with biopsy-proven NAFLD and 103 nonsteatotic control subjects who were matched for age and sex. The association between levels of PEDF and clinical, biochemical, and histological phenotypes was examined. Results: NAFLD patients had significantly higher serum PEDF levels (1.97 +/- 0.50 mu g/mL) than control subjects (1.51 +/- 0.49 mu g/mL, Student's t test, P<0.001). Multivariable-adjusted stepwise regression analysis showed that PEDF ([beta] = 0.32, t = 3.13, P = 0.002) and triglycerides ([beta] = 0.22, t = 2.23. P = 0.02) were, in the order they entered into the model, the main independent predictors of steatosis scores in our patients with NAFLD. Conclusions: Serum PEDF levels are significantly increased in patients with biopsy-proven NAFLD and are associated with liver steatosis independently of traditional risk factors.
Uludağ İç Hastalıkları kitabı, cilt 2: Semptomdan tanıya
(Bursa Uludağ Üniversitesi, 2022-10) Ersoy, Alparslan; Dilek, Kamil; Dolar, M. Enver; Güllülü, Mustafa; Nak, Selim Giray; Evrensel, Türkkan; Demircan, Celaleddin; Gürel, Selim; Ersoy, Canan Özyardımcı; Özkocaman, Vildan; Dalkılıç, Ediz; Gül, Özen Öz1; Cander, Soner; Pehlivan, Yavuz; Çubukçu, Erdem; Yıldız, Abdülmecit; Oruç, Ayşegül; Deligönül, Adem; Coşkun, Belkıs Nihan; Ersal, Tuba; Eren, Fatih; Ünsal, Yasemin Aydoğan; Şahin, Ahmet Bilgehan; Aydemir, Ensar; Ateş, Coşkun; Sali, Seda; Cesur, Selcan; Çoban, Eyüp; Boz, Saide Elif Güllülü; Coşkun, Alper; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.
Hekimlik eğitiminin en önemli aşamalarından birisi, her sisteme ait çok sayıda semptomu öğrenmek ve doğru yorumlamaktır. Bir semptom bazen birden fazla hastalıkta görülebilir, yani belirli bir sisteme spesifik olmayabilir. Hastalığın özelliği olan semptom ve bulgular hiçbir zaman hastalar arasında aynı şekilde karşımıza çıkmamaktadır. Algoritmalarla hastalarda semptomlara yaklaşmamız daha kolay olmaktadır. Bu nedenle genellikle semptomların karakterini iyi sorgulamak ve ayırt edici tanı yapmak durumunda kalırız. Sonuçta hastanın farklı semptomlarını bir araya getirerek o semptomların hangi hastalığı işaret ettiğini ortaya koymamız gerekmektedir. Çoğunlukla fizik muayene bulguları ile birlikte farklı incelemeler yapmamız tanı koymamızı mümkün kılar. Bu kitapta iç hastalıklarında semptomdan tanıya nasıl gideceğimizi öğrenmeniz amaçlanmıştır.
Uludağ İç Hastalıkları kitabı, cilt 3: Tanı ve tedavi
(Bursa Uludağ Üniversitesi, 2022-10) Ersoy, Alparslan; Dilek, Kamil; Ali, Rıdvan; Dolar, M. Enver; Güllülü, Mustafa; Yavuz, Mahmut; Gülten, Macit; Nak, Selim Giray; Ertürk, Erdinç; Özkalemkaş, Fahir; Evrensel, Türkkan; Demircan, Celaleddin; Gürel, Selim; Ersoy, Canan Özyardımcı; Özkocaman, Vildan; Kıyıcı, Murat; Dalkılıç, Ediz; Gül, Özen Öz; Cander, Soner; Pehlivan, Yavuz; Çubukçu, Erdem; Yıldız, Abdülmecit; Oruç, Ayşegül; Deligönül, Adem; Ersal, Tuba; Eren, Fatih; Şahin, Ahmet Bilgehan; Orhan, Sibel Oyucu; Bozkurt, Zeynep Yılmaz; Lermi, Nihal; Cesur, Selcan; Teker, Tufan; Ocak, Tuğba; Keskin, Mehmed Kürşad; Ekin, Ali; Coşkun, Alper; Büyükuysal, Rıfat Levent; Çavun, Sinan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Farmakoloji Anabilim Dalı.
Tanı koyabilmemiz için en azından toplumda sık karşılaştığımız hastalıklar hakkında yeterli bilgi sahibi olmamız gerekmektedir. Tanıda temel bilgileri uygulayarak semptomdan tanıya doğru bir yönde gitmemiz, aradığımız hastalığı bilmemize bağlıdır. Bilmediğimiz bir hastalığın semptom ve bulgularını tespit etsek bile o hastaya yararımız olmayacaktır. Hastalıklar her hastada her zaman aynı şekilde karşımıza çıkmazlar. Aynı tedavi de her hastada aynı sonucu vermeyebilir. Hekim tecrübe kazandıkça mesleğinde ustalaşır. Tedavi aşamasında hastalığın seyrini göre müdaheleler yapmamız, hasta yararına riskli kararlar almamız gerekebilir. Ayrıca uyguladığımız tedavilerin yan etkilerini iyi bilmemiz, hekimliğin temel ilkesi olan “önce zarar verme” ilkesinin dışına çıkmamızı engeller. Bu kitapta İç Hastalıklarının farklı branşlarında karşılaşacağınız birçok önemli hastalığa ve tedavilerine yer verilmiştir.
Üst gastrointestinal sistem kanamalarında erken endoskopinin mortalite ve morbiditeye etkisi
(2024-05-03) Hafızoğlu, Merve; Eren, Fatih; Gülten, Macit; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Gastroenteroloji Bilim Dalı; 0000-0003-2667-8963; 0000-0002-4186-0731
Üst gastrointestinal sistem (ÜGİS) kanamaları özofagusun üst kısmı ile Treitz ligamanı arasındaki herhangi bir yerden lümen içine olan kanamaları kapsar. ÜGİS kanaması olan hasta acil servise hematemez, melena veya hematokezya ile başvurabilir. Akut ÜGİS kanamalı hastalara ilk 24 saat içinde endoskopi uygulamak standart yaklaşımdır. Bununla birlikte erken endoskopinin tanımı konusunda ortak bir görüş yoktur. Çeşitli çalışmalara göre bu tanım acil servise başvurudan sonra 2 saat ile 24 saat arasında çeşitlilik gösterir. Bizim çalışmamızda ÜGİS kanaması ile acil servise başvuran 115 hasta alındı. Hastalar endoskopi yapılma sürelerine göre 3 gruba ayrıldığında (<8 saat, 8- 24 saat, >24 saat) gruplar arasında endoskopik bulgu, Forrest sınıflandırması, endoskopik veya cerrahi tedavi ihtiyacı, replasman ihtiyacı, takiplerde tekrarlayan kanama, tekrarlayan endoskopi ihtiyacı ve hastaların akıbeti konusunda anlamlı fark saptanmadı. Sonuç olarak ÜGİS kanamalarında erken endoskopinin tanımı, ilk 24 saat içinde ne zaman yapılacağı ve faydaları konusunda ortak bir görüş yoktur, yapılan prospektif randomize çalışmalar da erken endoskopinin kar zarar oranını belirlemede göz önünde bulundurulmalıdır.
Validation of risk scoring systems in ursodeoxycholic acid-treated patients with primary biliary Cholangitis
(Lippincott Williams & Wilkins, 2019-07) Eren, Fatih; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri.; 0000-0001-8126-2413; AAS-6286-2020; 12545949900
INTRODUCTION: Risk stratification based on biochemical variables is a useful tool for monitoring ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC). Several UDCA response criteria and scoring systems have been proposed for risk prediction in PBC, but these have not been validated in large external cohorts. METHODS: We performed a study on data of 1746 UDCA-treated patients with PBC from 25 centers in Europe, United States, and Canada. The prognostic performance of the risk scoring systems (GLOBE and UK-PBC) and the UDCA response criteria (Barcelona, Paris I, Paris II, Rotterdam, and Toronto) were evaluated. We regarded cirrhosis-related complications (ascites, variceal bleeding, and/or hepatic encephalopathy) as clinical end points. RESULTS: A total of 171 patients reached a clinical end point during a median 7 years (range 1-16 years) of follow-up. The 5-, 10- and 15-year adverse outcome-free survivals were 95%, 85%, and 77%. The GLOBE and UK-PBC scores predicted cirrhosis-related complications better than the UDCA response criteria. The hazard ratio (HR) for a 1 standard deviation increase was HR 5.05 (95% confidence interval (CI): 4.43-5.74, P < 0.001) for the GLOBE score and HR 3.39 (95% CI: 3.10-3.72, P < 0.001) for the UK-PBC score. Overall, the GLOBE and UK-PBC risk scores showed similar and excellent prognostic performance (C-statistic, 0.93; 95% CI: 0.91%-95% vs 0.94; 95% CI: 0.91%-0.96%). DISCUSSION: In our international, multicenter PBC cohort, the GLOBE and UK-PBC risk scoring systems were good predictors of future cirrhosis-related complications.