Browsing by Author "Gürel, Selim"
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Publication 96 weeks of pegylated-interferon- alpha-2α plus tenofovir or placebo for the treatment of hepatitis delta: The hidit-2 study(Wiley-blackwell, 2013-10-01) Wedemeyer, Heiner; Yurdaydin, Cihan; Ernst, Stefanie; Caruntu, Florin A.; Curescu, Manuela G.; Yalcin, Kendal; Akarca, Ulus S.; Zeuzem, Stefan; Erhardt, Andreas; Lueth, Stefan; Papatheodoridis, George; Keskin, Onur; Port, Kerstin; Celen, Mustafa K.; Stift, Judith; Heidrich, Benjamin; Mederacke, Ingmar; Hardtke, Svenja; Koch, Armin; Dienes, Hans P.; Manns, Michael P.; Gürel, Selim; GÜREL, SELİM; Bursa Uludağ Üniversitesi/Tıp Fakültesi; HLH-8209-2023Publication A transient early hbv-dna increase during peg-ifnα therapy of hepatitis d indicates loss of infected cells and is associated with hdv-rna and hbsag reduction(Wiley, 2020-12-12) Anastasiou, Olympia E.; Yurdaydin, Cihan; Maasoumy, Benjamin; Hardtke, Svenja; Caruntu, Florin Alexandru; Curescu, Manuela G.; Yalcin, Kendal; Akarca, Ulus S.; Zeuzem, Stefan; Erhardt, Andreas; Luth, Stefan; Papatheodoridis, George, V; Radu, Monica; Liebig, Stephanie; Bantel, Heike; Bremer, Birgit; Manns, Michael P.; Cornberg, Markus; Wedemeyer, Heiner; Gürel, Selim; GÜREL, SELİM; Bursa Uludağ Üniversitesi/Tıp Fakültesi; HLH-8209-2023HBV-DNA levels are low or even undetectable in the majority HDV-infected patients. The impact of PEG-IFN alpha on HBV-DNA kinetics in HDV-infected patients has not been studied in detail. We analysed data of a prospective treatment trial where 120 HDV-RNA-positive patients were randomized to receive PEG-IFN alpha-2a plus tenofovir-disoproxil-fumarate (PEG-IFN alpha/TDF, n = 59) or placebo (PEG-IFN alpha/PBO; n = 61) for 96 weeks. At week 96, HBV-DNA was still quantifiable in 71% of PEG-IFN alpha/PBO-treated patients but also in 76% of PEG-IFN alpha/TDF-treated patients, despite low HBV-DNA baseline values. Surprisingly, a transient HBV-DNA increase between weeks 12 and 36 was observed in 12 in PEG-IFN alpha/TDF-treated and 12 PEG-IFN alpha/PBO-treated patients. This increase was positively associated with HBsAg loss [(P = 0.049, odds ratio (OR) 5.1] and HDV-RNA suppression (P = 0.007, OR 4.1) at week 96. Biochemical markers of cell death (M30 and ALT) were higher during the HBV-DNA peak but no distinct systemic immune pattern could be observed by screening 91 soluble inflammatory markers. In conclusion, an early increase in HBV-DNA during PEG-IFN alpha-2a therapy occurred in more than 20% of patients, even in TDF-treated patients. This transient HBV-DNA rise may indicate PEG-IFN alpha-induced cell death and lead to long-term HDV-RNA suppression and HBsAg loss.Item Acil servise epigastrik ağrı yakınmasıyla başvuran hastalarda helicobacter pylori sıklığı ve tanıda kalitatif serum Ig G testinin yeri(Uludağ Üniversitesi, 2004-02-25) Bulut, Mehtap; Armağan, Erol; Kıyıcı, Murat; Balcı, Veysel; Atar, Nurşen; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Bilim Dalı.Çalışmamızın amacı acil servise epigastrik ağrı ile başvuran hastalarda H. pylori sıklığını saptamada Rapid H. pylori cassette testi ile üreaz testinin sensitivite ve spesifisitesini karşılaştırmaktır. Bu çalışma, ocak 2000 ile şubat 2001 tarihleri arasında prospektif olarak yapıldı. Hastalardan alınan 2-3 cc kanın santrifüj edilmesiyle hazırlanan serum, Rapid H. pylori cassette testi için kullanıldı. Sonra hastalara endoskopi yapıldı ve ayrıca H. Pylori üreaz testine bakıldı. Toplam olgu sayısı 47 olup (21 erkek, 26 kadın) yaş ortalaması 38.5 (16-71) yıl idi. Endoskopi ile 19 hastaya gastrit, 10 hastaya peptik ülser tanısı kondu H. pyloriyi saptamada üreaz testi ile Rapid H. pylori testi arasında istatistiksel olarak anlamlı bir fark saptanmadı. Üreaz testi ile karşılaştırıldığında Rapid H. pylori testinin spesifisite, sensitivitesi sırasıyla %81.4 ve %95 olarak saptandı. Non-invazif bir yöntem olan ve kolaylıkla uygulanabilen serum Rapid H. pylori cassette testinin spesifisite ve sensitivitesi invazif H. pylori üreaz testi ile karşılaştırıldığında kabul edilebilir sonuçlar ortaya koymuştur. Bu nedenle endoskopi yapma imkanı olmadığı durumlarda bu testin kullanılması önerilebilir.Item After the eradication of helicobacter pylori infection, relapse is a serious problem in Turkey(Lippincott Williams & Wilkins, 1999) Besisk, Fatih; Demir, Kadir; Mungan, Zeynel; Kaymakoğlu, Sabahattin; Bozta, Güngör; Çakaloğlu, Yilmaz; Yeğinsu, Oktay; Ökten, Atilla; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.Eradication of Helicobacter pylori (Hp) infection is strongly recommended in duodenal and gastric ulcer. In developed countries the recurrence rate is low; however, in Turkey, the Hp recurrence rate is suspected to be high as the prevalence of Hp infection is-as high as 70-80% in the asymptomatic population. We planned this study to determine the relapse rate of Hp infection after successful eradication therapy in Turkey. Fifty-two cases including 24 patients with duodenal ulcer and 28 patients with nonulcer dyspepsia were examined in this study. The eradication regimen was omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily, and metronidazole 500 mg three times a day for 1 week. All patients underwent upper gastrointestinal tract endoscopy. At least four samples from antrum and corpus were taken to enable histologic diagnosis of Hp infection. After the eradication therapy, endoscopy was repeated at 1, 3, 6, and 12 months, and Hp-positive patients were dropped from study. With the use of this regimen, the Hp eradication rate was 92.3% (48/52). After the eradication of Hp infection, relapse rates were 6.97%, 27.5%, and 11.11% at 3, 6, and 12 months, respectively. The cumulative relapse rate for 1 year was 41.46%. The results of this study revealed that after the eradication of Hp infection, recurrence is encountered very often as a problem in Turkey. We concluded that hygienic and environmental factors can affect these high relapse rates.Publication Anti-HDV IgM as a marker of disease activity in hepatitis delta(Public Library Science, 2014-07-29) Wranke, Anika; Heidrich, Benjamin; Ernst, Stefanie; Serrano, Beatriz Calle; Caruntu, Florin Alexandru; Curescu, Manuela Gabriela; Yalcin, Kendal; Gürel, Selim; Zeuzem, Stefan; Erhardt, Andreas; Lueth, Stefan; Papatheodoridis, George V.; Bremer, Birgit; Stift, Judith; Grabowski, Jan; Kirschner, Janina; Port, Kerstin; Cornberg, Markus; Falk, Christine S.; Dienes, Hans-Peter; Hardtke, Svenja; Manns, Michael P.; Yurdaydin, Cihan; Wedemeyer, Heiner; HIDIT-2 Study Grp; GÜREL, SELİM; Uludağ Üniversitesi/Tıp Fakültesi.; HLH-8209-2023Background: Hepatitis delta frequently leads to liver cirrhosis and hepatic decompensation. As treatment options are limited, there is a need for biomarkers to determine disease activity and to predict the risk of disease progression. We hypothesized that anti-HDV IgM could represent such a marker.Methods: Samples of 120 HDV-infected patients recruited in an international multicenter treatment trial (HIDIT-2) were studied. Anti-HDV IgM testing was performed using ETI-DELTA-IGMK-2-assay (DiaSorin). In addition, fifty cytokines, chemokines and angiogenetic factors were measured using multiplex technology (Bio-Plex System). A second independent cohort of 78 patients was studied for the development of liver-related clinical endpoints (decompensation, HCC, liver transplantation or death; median follow up of 3.0 years, range 0.6-12).Results: Anti-HDV IgM serum levels were negative in 18 (15%), low (OD<0.5) in 76 (63%), and high in 26 (22%) patients of the HIDIT-2 cohort. Anti-HDV IgM were significantly associated with histological inflammatory (p<0.01) and biochemical disease activity (ALT, AST p<0.01). HDV replication was independent from anti-HDV IgM, however, low HBV-DNA levels were observed in groups with higher anti-HDV IgM levels (p<0.01). While high IP-10 (CXCL10) levels were seen in greater groups of anti-HDV IgM levels, various other antiviral cytokines were negatively associated with anti-HDV IgM. Associations between anti-HDV IgM and ALT, AST, HBV-DNA were confirmed in the independent cohort. Clinical endpoints occurred in 26 anti-HDV IgM positive patients (39%) but in only one anti-HDV IgM negative individual (9%; p = 0.05).Conclusions: Serum anti-HDV IgM is a robust, easy-to-apply and relatively cheap marker to determine disease activity in hepatitis delta which has prognostic implications. High anti-HDV IgM levels may indicate an activated interferon system but exhausted antiviral immunity.Item Anti-HDV immunoglobulin M testing in hepatitis delta revisited: Correlations with disease activity and response to pegylated interferon-alpha 2a treatment(Int Medical, 2012) Mederacke, Ingmar; Yurdaydın, Cihan; Dalekos, George N.; Bremer, Birgit; Erhardt, Andreas; Çakaloğlu, Yılmaz; Yalçın, Kendal; Zeuzem, Stefan; Zachou, Kalliopi; Bozkaya, Hakan; Dienes, Hans Peter; Manns, Michael P.; Wedemeyer, Heiner; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; 7003706434Background: The role of anti-HDV immunoglobulin M (IgM) testing in patients receiving pegylated interferon-alpha therapy for hepatitis delta is unknown. We performed anti-HDV IgM testing in a well defined cohort of HDVinfected patients who were treated with pegylated interferon-alpha 2a plus adefovir, or either drug alone. Methods: Sera from 33 HDV-RNA-positive patients from the international HIDIT-1 trial were available for anti-HDV IgM testing (ETI-DELTA-IGMK-2 assay, DiaSorin, Saluggia, Italy) before therapy, at treatment weeks 24 and 48, and at 24 weeks after the end of treatment. Results: Anti-HDV IgM tested positive in 31 out of the 33 patients (94%) prior to treatment. HDV IgM levels correlated with histological inflammatory activity (r= 0.51, P<0.01) and were higher in patients with alanine aminotransferase and gamma-glutamyl transpeptidase levels above the median (P<0.05). Quantitative anti-HDV IgM values declined in patients responding to antiviral therapy, however anti-HDV IgM remained positive after treatment in the majority of virological responders. Conclusions: We suggest that anti-HDV IgM testing might give additional useful information to determine disease activity in hepatitis delta and to predict treatment response to antiviral therapy with type I interferons. However, determination of anti-HDV IgM can not substitute HDV RNA testing, which remains the primary virological marker for response to therapy.Item Anti-hdv-igm testing in hepatitis delta revisited: Correlations with disease activity and response to pegylated interferon alfa-2a treatment(Elsevier, 2010) Mederacke, Ingmar; Yurdaydın, Cihan; Bremer, Birgit; Çakaloğlu, Yılmaz; Erhardt, A.; Yalçın, Kendal; Zachou, Kalliopi; Heidrich, Benjamin; Dalekos, Georgios N.; Dienes, Hans P.; Manns, M. P.; Wedemeyer, Heiner; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.Item Antifosfolipit antikorlar ve antifosfolipit sendrom (iki olgu nedeniyle)(Uludağ Üniversitesi, 1995-11-29) Koç, Bayram; Bulucu, Fatih; Pay, Salih; Özcan, Nurettin; Gürel, SelimBu makalede; antifosfolipid antikor tespit edildi , tekrarlayan abortus tromboz ve trombositopenili bir bayan ile tekrarlayan trombozis ve trombositopenili bir erkek hasta sunulmaktadır. Bu nedenle antifosfolipit antikorlar ve antifosfolipid sendrom gözden geçirildi.Publication Association between ALT flares and HBeAg loss and HBsAg decline in Patients with Chronic Hepatitis B during treatment with Tenofovir Disoproxil Fumarate or Adefovir Dipivoxil(Lippincott Williams & Wilkins, 2015-10-01) Marcellin, Patrick; Gane, Edward J.; Krastev, Zahary; Gürel, Selim; Dusheiko, Geoffrey M.; Gaggar, Anuj; Massetto, Benedetta; Kim, Kyungpil; Flaherty, John F.; Subramanian, Mani; Janssen, Harry L.; Buti, Maria; GÜREL, SELİM; Uludağ Üniversitesi/Tıp Fakültesi.; HLH-8209-2023Item Association between level of hepatitis d virus RNA at week 24 of pegylated interferon therapy and outcome(Elsevier, 2015-12) Keskin, Onur; Wedemeyer, Heiner; Tüzün, Ali; Zachou, Kalliopi; Deda, Xheni; Dalekos, George N.; Heidrich, Benjamin; Pehlivan, Selcen; Zeuzem, Stefan; Yalçın, Kendal; Tabak, Fehmi; İdilman, Ramazan; Bozkaya, Hakan; Manns, Michael; Yurdaydın, Cihan; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; 7003706434BACKGROUND & AIMS: Interferon is the only effective treatment for chronic hepatitis D virus (HDV) infection. No rules have been set for stopping treatment based on viral kinetics. We analyzed data from an international study of hepatitis D treatment to identify factors associated with outcomes of pegylated interferon treatment, with and without adefovir. METHODS: We analyzed data from the Hep-Net-International Delta Hepatitis Intervention Trial on 50 patients with compensated liver disease who tested positive for anti-HDV and HDV RNA. Subjects received pegylated interferon alpha 2a, with adefovir or placebo, or only adefovir, for 48 weeks. Twenty-four weeks after treatment ended, 41 patients were evaluated for levels of HDV RNA and DNA, liver enzymes, and hepatitis B surface antigen (HBsAg); liver biopsy specimens were analyzed for fibrosis. Response to therapy was defined as end-of-treatment response or post-treatment week 24 virologic response. In both cases virologic response was associated with undetectable HDV RNA levels. Patients with less than a 1 log decrease in HDV RNA at the end of treatment were considered null responders. RESULTS: Based on univariate and multivariate analysis, the level of HDV RNA at week 24 of treatment was associated more strongly with response to therapy than other factors analyzed. The level of HBsAg at week 24 of treatment was associated with a response to therapy only in univariate analysis. Lack of HDV RNA at week 24 of treatment, or end of treatment, identified responders with positive predicted values of 71% and 100%, respectively. At 24 weeks after treatment, a decrease in HDV RNA level of less than 1 log, combined with no decrease in HBsAg level, identified null responders with a positive predictive value of 83%. A decrease in HDV RNA level of more than 2 log at week 24 of treatment identified null responders with a negative predictive value of 95%. CONCLUSIONS: Based on an analysis of data from a large clinical trial, the level of HDV RNA at week 24 of treatment with pegylated interferon, with or without adefovir for 48 weeks, can identify patients who will test negative for HDV RNA 24 weeks after the end of treatment. This information can be used to help physicians manage patients receiving therapy for chronic hepatitis D.Item AST/ALT ratio is not useful in predicting the degree of fibrosis in chronic viral hepatitis patients(Lippincott Williams & Wilkins, 2015-12) Eminler, Ahmet Tarık; Ayyıldız, Talat; Irak, Kader; Kıyıcı, Murat; Gürel, Selim; Dolar, Enver; Gülten, Macit; Nak, Selim G.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; 0000-0002-3208-6211; AAG-9177-2021; AAI-4213-2021; 37080733400; 6507627491; 7003706434; 6602075084; 6603629209; 6603336505Background and aim Noninvasive tests are primarily used for staging hepatic fibrosis in patients with chronic liver disease. In clinical practice, serum aminotransferase levels, coagulation parameters, and platelet count have been used to predict whether or not a patient has cirrhosis. In addition, several studies have evaluated the accuracy of combinations (or ratios) of these measures. The present study aimed to investigate the relationship between five noninvasive models [AST/ALT ratio (AAR), aspartate aminotransferase to platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), age-platelet index (APind), and King's score] and the degree of hepatic fibrosis as determined by biopsy in patients with chronic hepatitis B and C. Patients and methods A total of 380 patients with viral hepatitis (237 with chronic hepatitis B and 143 with chronic hepatitis C) who were seen at our clinic between January 2005 and January 2011 were retrospectively analyzed. The degree of fibrosis was determined using the Ishak score. Patients with a fibrosis score of 0-2 were considered to have low fibrosis and those with a score between 3 and 6 were considered to have high fibrosis. Five noninvasive models were compared between the groups with low and high fibrosis. Results There were statistically significant differences between the hepatitis B and C patients with high and low fibrosis with respect to APind (4.492.35 vs. 2.41 +/- 1.84; P<0.001 in hepatitis B and 4.83 +/- 2.25 vs. 2.92 +/- 1.88; P<0.001 in hepatitis C), APRI (1.00 +/- 1.17 vs. 0.47 +/- 0.39; P<0.001 in hepatitis B and 1.01 +/- 1.01 vs. 0.41 +/- 0.29; P<0.001 in hepatitis C), CDS (4.53 +/- 1.90 vs. 3.58 +/- 1.30; P<0.001 in hepatitis B and 4.71 +/- 2.03 vs. 3.42 +/- 1.49; P<0.05 in hepatitis C), and King's score (24.31 +/- 3.14 vs. 7.65 +/- 6.70; P<0.001 in hepatitis B and 24.82 +/- 2.55 vs. 8.33 +/- 7.29; P<0.001 in hepatitis C). There were no significant differences in the AAR between the hepatitis B and C patients with high and low fibrosis (0.78 +/- 0.31 vs. 0.74 +/- 0.34; P=0.082 in hepatitis B and 0.91 +/- 0.40 vs. 0.85 +/- 0.27; P=0.25 in hepatitis C). The area under the receiver-operating characteristic curve of the APind, APRI, CDS, and King's score in the hepatitis B group were 0.767, 0.710, 0.646, and 0.770, respectively; these values were 0.732, 0.763, 0.677, and 0.783, respectively, in the hepatitis C group. Conclusion In conclusion, our data suggest that four of the five noninvasive methods evaluated in this study can be used to predict advanced fibrosis in patients with hepatitis B and C. However, there was no significant relationship between the degree of hepatic fibrosis and the AAR score, indicating that AAR is not useful in estimating the fibrosis stage in hepatitis B and C patients.Item Barrett özofagusu ve özofagus kanserlerinde p53 protein ekspresyonu(Uludağ Üniversitesi, 2001) Görgülü, Numan; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.AMAÇ: Günümüzde pek çok malign tümör gelişiminde onkogen ve tümör süpressör gen mutasyonları rol oynamakta ve bu genlerin ürünü olan onkoproteinler, immünohistokimyasal boyamalarla tümör hücrelerinde gösterilebilmektedir. Normalde apoptozisi uyaran onkoproteinlerden olan p53 proteininin mutasyonuna özofagus kanserlerinde sık rastlanmaktadır. Bu çalışmada, ülkemizde oldukça sık görülen ve önemli bir ölüm sebebi olan özofagus kanserlerinde p53 onkoprotein ekspresyonunun ne kadar görüldüğü, hastalığın patolojik tipi ile bir ilişki olup olmadığı ve prekanseröz bir lezyon olan Barrett özofagusundaki p53 onkoprotein ekspresyonu araştırılmıştır. GEREÇ VE YÖNTEM: 1995-2001 yılları arasında Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı Gastroenteroloji Bilim Dalı'nda tetkik edilerek Patoloji Bilim Dalı'nda histopatolojik olarak Barrett özofagusu veya özofagus kanseri tanısı konmuş toplam 78 hasta seçildi. Barrett özofaguslu olguların endoskopik biyopsi materyallerine immünohistokimyasal yöntemlerle Alcian-blue ve p53; özofagus adenokarsinomlu veya epidermoid karsinomlu olguların endoskopik veya ameliyat materyallerine ise sadece p53 protein ekspresyonunu gösteren boyamalar uygulandı. SONUÇ: Çalışmaya alınan 78 hastanın 23'ü Barrett özofagusu; 27'si özofagus adenokarsinomu, 28'i ise epidermoid karsinom olup, Barrett özofaguslu olgularda p53 ile pozitif boyanma % 60.8, özofagus adenokarsinomlularda % 40.7 ve epidermoid karsinomlularda % 60.7 olarak bulundu. p53 boyanma açısından Barrett özofagusu ile özofagus adenokarsinom veya epidermoid karsinom arasında bir ilişki saptanamadı. Sonuç olarak, özofagus kanserine predispozan bir faktör olan Barrett özofagusu ve gerek adenokarsinom gerekse de epidermoid karsinomlu vakalarda p53 protein ekspresyonunun bir önemi olmadığı kanaatine varıldı.Item Baseline and salt-stimulated paraoxonase and arylesterase activities in patients with chronic liver disease: Relation to disease severity(Wiley, 2009-04) Keskin, Murat; Dolar, Engin; Dirican, Melahat; Kıyıcı, Murat; Yılmaz, Yusuf; Gürel, Selim; Nak, Selim Giray; Gülten, Macit; Erdinç, Selda; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyokimya Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; 0000-0003-4518-5283; 0000-0002-3208-6211; 0000-0003-4526-4352; AAI-4213-2021; AAG-9177-2021; AAG-6985-2021; 23050640000; 6602075084; 6601919847; 6507627491; 22936014300; 7003706434; 6603336505; 6603629209; 24334883200Background: It has been recently reported that serum paraoxonase (PON1) and arylesterase (ARE) activities may be significantly reduced in patients with chronic liver disease. The aim of the study was to investigate the relations between serum PON1 and ARE activities and the degree of liver damage in patients with chronic liver injury. Methods: We studied a total of 75 patients with chronic liver disease (50 patients with cirrhosis and 25 patients with chronic hepatitis) and 25 healthy comparison subjects. Baseline and salt-stimulated PON1 and ARE activities were determined in all study participants. Results: Baseline and stimulated PON1 and ARE activities were significantly lower in patients with chronic liver disease than in controls. Cirrhotic patients in Child-Pugh classes B and C subgroups had significantly reduced PON1 and ARE activities compared with Child-Pugh class A patients (both P-values < 0.01). Receiver operating characteristic curve analysis showed that serum ARE activity was the most effic Conclusion: Baseline and stimulated PON1 and ARE activities are reduced in patients with chronic liver disease. Serum ARE activity could be a suitable biomarker for the evaluation of the presence and severity of chronic liver damage.Item Bursa Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Merkezi'nde immünsüpresif tedavi nedenli hepatit B reaktivasyon riski olan hastalarda profilaktik tenofovir alafenamid kullanımının retrospektif incelenmesi(Bursa Uludağ Üniversitesi, 2022) Aydın, Seray Türe; Gürel, Selim; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.Hepatit B virüsü (HBV) ile enfekte olmuş bireyler immünsüpresif veya antikanser tedavileri aldıklarında HBV reaktivasyonu (HBVr) riski artmaktadır. HBV reaktivasyonu ciddi morbidite ve mortalite ile sonuçlanabilmektedir. Günümüzde kanser tedavileri, monoklonal antikor tedavisi, steroid kullanımı, biyolojik ajanlarla tedavi olan hastaların sayısı giderek artmaktadır. İmmünsüpresif tedavi öncesi hepatit taraması yapılmalı, hepatit B reaktivasyon riskine göre proflaktik antiviral tedavi başlanmalıdır. Çalışmamızda Ocak 2019-Mart 2022 tarihleri arasında immünsüpresif tedavi nedenli proflaktif tenofovir alafenamid fumarat (TAF) kullanan 211 hastanın retrospektif incelenmesi yapılmıştır. Hastaların demografik özellikleri, tedavi öncesi ve sonrası hepatit serolojisi ve laboratuvar özellikleri, altta yatan hastalıkları, immünsüpresif tedavileri, serolojik riskleri, HBV reaktivasyon risk durumları değerlendirildi. Tanı anında 26 (%12,3) hasta HBsAg pozitif olup, 185 (%87,7) hasta ise HBsAg negatif/ anti-HBc total pozitifliği vardır. Anti-CD20 monoklonal antikorları HBV reaktivasyonu için yüksek riskli immünsüpresif ajan olup, %23,70 hastanın tedavisinde kullanılmıştır. Tedavi öncesi ve sonrası değerler karşılaştırılığında HBsAg, anti-HBc total, anti-HBs serolojisinde ve labarotuvar özelliklerinde anlamlı farklılık tespit edilmemiştir. HBV DNA ise tedavi sonrasında anlamlı olarak azalmıştır. Sonuç olarak; retrospektif olarak analizi yapılan 211 hastada reaktivasyon gözlenmemiştir. Bu çalışmada TAF’ın da HBVr önlemede diğer antiviraller kadar etkin olduğu gösterilmiştir. Renal fonksiyon bozukluğu olanlarda renal doz ayarı gerektirmemesi ve renal fonksiyonlar üzerine olumsuz etkisi olmaması, HBV DNA’yı baskılaması, yan etki profilinin az olması gibi sebeplerle güvenle proflaksi tedavisinde de kullanılabilir.Item A case of torsion of the wandering spleen presenting as hypersplenism and gastric fundal varices(Türk Gastroenteroloji Derneği, 2011-02) Irak, Kader; Esen, İrfan; Keskin, Murat; Eminler, Ahmet Tarık; Ayyıldız, Talat; Kaya, Ekrem; Kıyıcı, Murat; Gürel, Selim; Nak, Selim Giray; Gülten, Macit; Dolar, Enver; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji ve Hepatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel cerrahi Anabilim Dalı.; 0000-0001-6262-2866; ABF-1568-2021; AAG-4473-2019; AAG-9177-2021; R-8751-2019; AAI-4213-2021; 37080733400; 49861308400; 23050640000; 23050640000; 24066287600; 6603155277; 7004568109; 6507627491; 7003706434; 6603336505; 6603629209; 6602075084Wandering spleen is the displacement of the spleen from its normal location due to the loss or weakening of ligaments that hold the spleen in the left upper quadrant. The possibility of torsion of the spleen is high due to the long and mobile nature of the vascular pedicle. Generally, cases are asymptomatic. Under conditions of delayed diagnosis, symptoms of splenomegaly, left portal hypertension, gastric fundal varices, and hypersplenism. may present as a result of development of vascular congestion associated with chronic torsion. There are only a few cases in the literature reporting the association of wandering spleen and fundal vat-ices. We report herein the case of a 55-year-old female who admitted to our clinic with complaints of fatigue and epigastric pain. She was determined to have gastric fundal varices and hypersplenism secondary to the development of left portal hypertension due to chronic splenic torsion.Item Characterization of changes in FibroTest values during treatment with tenofovir alfenamide (TAF) Or tenofovir disproxil fumarate (TDF) in patients with CHB(Wiley, 2016-10) Izumi, Namiki; Tsang, Owen Tak Yin; Ahn, Sang Hoon; Angus, Peter W.; Flaherty, John F.; Kim, Kyungpil; Gaggar, Anuj; Suri, Vithika; Subramanian, Mani; Cooper, Curtis; Hann, Hie-Won; Acharya, Subrat K.; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi.; HLH-8209-2023Item Colitis cystica profunda(Aves, 2007-09) Dolar, Enver; Kıyıcı, Murat; Yılmazlar, Tuncay; Gürel, Selim; Nak, Selim Giray; Gülten, Macit It; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; 0000-0001-8944-2793; 0000-0002-3208-6211; HLH-8209-2023; AAI-4213-2021; AAG-9177-2021; 6602075084; 6507627491; 6701800362; 7003706434; 6603336505; 6603629209Item Continued efficacy and safety through 4 years of tenofovir disoproxil fumarate (tdf) treatment in hbeag-negative patients with chronic hepatitis b (study 102): Preliminary analysis(Wiley, 2010-10) Marcellin, Patric; Buti, Maria; Krastev, Zahary; Di Bisceglie, Adrian M.; Odin, Joseph A.; Dusheiko, Geoffrey; Heathcote, E. Jenny; E. Jenny, Katyna; Coombs, Derek; Mondou, Elsa; Anderson, Jane; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.Item Efficacy and safety of tenofovir alafenamide (TAF) at 96 weeks in chronic HBV (CHB) patients with risk factors for use of tenofovir disoproxil fumarate (TDF)(Wiley, 2017-10) Buti, Maria; Stepanova, Tatjana; Celen, Mustafa K.; Flisiak, Robert; Ryder, Stephen D.; Streinu, Adrian Cercel; Flaherty, John F.; Gaggar, Anu; Suri, Vithika; Mo, Shuyuan; Subramanian, Mani; Nurmukhametova, Elena; Zoulim, Fabien; Andreone, Pietro; Marcellin, Patrick; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/Dahiliye Anabilim Dalı/Gastroenteroloji Bilim Dalı.; HLH-8209-2023Item Efficacy of direct acting antiviral agents in dialysis patients with chronic hepatitis c virus infection on the kidney transplant waiting list: A single center experience(Transplantation, 2018-07) Oruç, Aysegül; Yıldız, Abdulmecit; Öztürk, Tuba; Gürel, Selim; Akgür, Suat; Ersoy, Alparslan; Uludağ Üniversitesi/Tıp Fakültesi/Nefroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Anabilim Dalı.; 0000-0002-0342-9692; 0000-0002-0710-0923; AAH-4002-2021; HLH-8209-2023; AAH-5054-2021