Background: Liver biopsy, which is considered the best method for evaluating hepatic fibrosis, has important adverse events. Therefore, non-invasive tests have been developed to determine the degree of hepatic fibrosis in patients with chronic hepatitis B.Aim: To verify the usefulness of a new fibrosis index the globulin/platelet model in patients with chronic hepatitis B and to compare it with other noninvasive tests for predicting significant fibrosis. This study was the second to evaluate the globulin/platelet model in HBV patients.Methods: We retrospectively investigated 228 patients with chronic hepatitis B who performed liver biopsy from 2013 to 2014. The globulin/platelet model, APGA [AST/Platelet/Gammaglutamyl transpeptidase/Alfa-fetoprotein], FIB4, fibrosis index, cirrhosis discriminate score, and Fibro-quotient were calculated, and the diagnostic accuracies of all of the fibrosis indices were compared between the F0-2 (no-mild fibrosis) and F3-6 (significant fibrosis) groups.Results: All of the noninvasive markers were significantly correlated with the stage of liver fibrosis (p < 0,001). To predict significant fibrosis (F ≥ 3), the area under the curve (95% CI) was found to be greatest for APGA (0.83 [0.74-0.86 ). The area under the receiver operating characteristic curves of APGA was significantly higher than that of the other noninvasive fibrosis markers (p < 0.05).Conclusions: While the APGA index was found to be the most valuable test for the prediction significant fibrosis in patients with chronic hepatitis B, GP model was the thirth valuable test. Therefore, we recommended that APGA could be used instead of the GP model for prediction liver fibrosis.

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Mean values of subfoveal, nasal, temporal choroidal, and macular thickness for the four quadrants were significantly lower in patients with β-thalassemia minor than in healthy controls.

Methotrexate (MTX) is an antiproliferative agent that is used in the treatment of patients with rheumatoid arthritis (RA). It can cause pancytopenia, which is observed rarely but can be fatal. In this article, we present three RA cases on MTX with multiple risk factors and comorbid diseases who developed MTX toxicity and pancytopenia. We suggest that there should be risk classifications for RA patients who are candidates for MTX treatment. Patients with multiple risk factors, those with poor cooperation who might have problems in receiving medication, and those who do not seem to follow regular visits might be better started on another disease-modifying agent. Key Words: Methotrexate, pancytopenia, risk factors ÖzetMetotreksat (MTX), romatoid artritli (RA) hastaların tedavisinde kullanılan antiproliferatif bir ajandır. Düşük doz MTX tedavisi, az görülen, fakat fatal olabilen bir yan etki olan pansitopeni tablosuna neden olabilir. Bu yazıda, RA tanısı ile MTX tedavisi almakta olan, çok sayıda risk faktörü ve eşlik eden hastalıkları olup, MTX'e bağlı pansitopeni gelişen üç olgu sunuldu. Romatoid artrit tanısı olan ve MTX tedavisine aday olan hastalarda, risk sınıflaması yapılması gerektiğini önermekteyiz. Multipl sayıda risk faktörü taşıyan, ilacı düzenli ve uygun şekilde alamayacak, aynı zamanda da düzenli takiplere gelemeyecek hastalarda MTX yerine farklı modifiye edici ajanlar tercih edilmelidir.

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