The Injector

Current treatment of hepatitis C infection

2023-11-20T09:43:31+03:00

Hepatitis C Virus (HCV) is a RNA virus causing HCV infection. HCV infection is an important cause of cirrhosis, hepatocellular carcinoma (HCC), and death. Interferons were the first agents used to treat HCV infection. Low success rates and serious side effects limited the use of interferons. The discovery of direct-acting antivirals (DAAs), stemming from a deep understanding of the virus's structure, life cycle, and viral proteins, has led to significant advancements in treatment. Currently, all patients infected with HCV can be treated with a high success rate. Thanks to pangenotypic treatments, it is not necessary to determine the genotype of the virus before treatment. DAAs are safer in terms of side effects. Cirrhosis status, comorbidities, and drug-drug interactions should be considered when planning treatment. The World Health Organization (WHO) aims to eliminate hepatitis C infection by 2030. In order to achieve this elimination, patients need to be diagnosed and receive effective treatment. DAAs are effective tools to achieve this aim. In this review, the microbiology, epidemiology, diagnosis, and treatment of HCV infection are presented. Treatment is described in detail from past to present.

Immunohistochemical analysis of Sonic Hedgehog in gastric adenocarcinoma and the relationship between mucin and HER2 expressions

2023-11-14T10:06:35+03:00

Objective: Most of the gastric adenocarcinomas are still recognized in advanced stages despite the improvements in diagnostic methods. Inhibition of the SHH pathway is predicted to be a targeted therapy in advanced gastric adenocarcinomas. Determining the relationship of the SHH pathway with other prognostic markers in gastric cancers is being investigated in terms of patient management. This study aimed to investigate the relationship between Sonic Hedgehog (SHH) and mucin core proteins (MUCs) antibody expressions with prognosis and Human epidermal growth factor receptor-2 (HER2) levels in gastric adenocarcinomas.

Methods: Eighty-six patients diagnosed with gastric adenocarcinoma in surgical resection material between 2008-2014 were included in the study. The clinicopathological findings of the cases were recorded from hospital documents. Pathologic diagnoses were reclassified based on WHO (2019) classifications. An examination of MUC1, MUC2, MUC5AC, MUC6, SHH, and HER2 antibodies was performed immunohistochemically. The tissue microarray technique was used in the study. The clinicopathological findings were statistically evaluated by comparing them with the immunohistochemical findings and survival.

Results: The study found that tumor diameter, lymphovascular embolus, perineural invasion, lymph node metastasis, and tumor depth had a statistically significant impact on survival. Additionally, the immunohistochemical examination showed no correlation between SHH, mucin antibodies, and HER2 scores with survival. According to our results, HER2 overexpression was associated with MUC1 to luminal staining (p=0.0001). When HER2 expression and SHH expressions were compared, all cases with HER2 overexpression were found to be positive with SHH (p=0.03). This is the first study to determine the relationship between SHH, MUC1, and HER2 immunohistochemical expressions in gastric adenocarcinomas.

Conclusion: Examining the HER2 relationship between SHH and MUC1 expressions we have shown, with future genetic and molecular studies, will provide an understanding of different malignancy pathways in gastric adenocarcinomas.

Frequency and clinicopathologic features of DNA mismatch repair protein deficiency in colorectal carcinoma in Turkish population

2023-11-13T16:29:49+03:00

Objective: Microsatellite instability pathway caused by loss of DNA “Mismatch Repair genes” (MMR) is responsible of Lynch Syndrome-related tumors and 10-15% of sporadic colorectal cancers. Although MSI-test is regarded as the golden standard for detection of “Lynch Syndrome-related tumors”, there are increasing evidence on similar analytic sensitivity of immunohistochemical evaluations.

Methods: We retrospectively evaluated 1,002 colorectal tumors for loss of DNA MMR protein (MLH1, PMS2, MSH2, MSH6) immunohistochemically. The results were correlated with clinicopathological features and high level-microsatellite instability (MSI-H) related histological parameters.

Results: MMR protein expression loss was observed in 9.8% of the cases. MLH1-PMS2 loss (53.2%) was the most common loss followed by MSH2-MSH6 (31.6%), isolated PMS2 loss (12%), and isolated MSH6 loss (2%). MMR deficiency was more frequent under 50 years-old (p<0.0001), in right colon tumors (p<0.0001), poorly differentiated tumors (p<0.0001), tumors with tumor infiltrating lymphocytes (p<0.0001), mucinous component (p=0.001), and medullary component (p<0.0001). Also MMR deficiency was less frequent in tumor with tumor budding (p<0.0001) and dirty necrosis (p<0.0001). The 5 years-survival rate was 55.7%. No significant correlation was found with MMR deficiency and survival.

Conclusions: MMR deficiency was observed in 9.8% of the cases with distinct clinicopathological features. The results were consistent with previous studies. Unlike the literature, we did not find any statistically significant difference between MMR deficiency and prognosis.