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Öğe Albendazole Induced Recurrent Acute Toxic Hepatitis: A Case Report(Univ Catholique Louvain-Ucl, 2017) Bilgic, Yilmaz; Yilmaz, Cengiz; Cagin, Yasir Furkan; Atayan, Yahya; Karadag, Nese; Harputluoglu, Murat Muhsin MuhipIntroduction : Drug induced acute toxic hepatitis can be idiosyncratic. Albendazole, a widely used broad spectrum antiparasitic drug is generally accepted as a safe drug. It may cause asymptomatic transient liver enzyme abnormalities but acute toxic hepatitis is very rare. Case Report : Herein, we present the case of 47 year old woman with recurrent acute toxic hepatitis after a single intake of albendazole in 2010 and 2014. The patient was presented with symptoms and findings of anorexia, vomiting and jaundice. For diagnosis, other acute hepatitis etiologies were excluded. Roussel Uclaf Causality Assessment Method (RUCAM) score was calculated and found to be 10, which meant highly probable drug hepatotoxicity. Within 2 months, all pathological findings came to normal. Result : There are a few reported cases of albendazole induced toxic hepatitis, but at adults, there is no known recurrent acute toxic hepatitis due to albendazole at this certainty according to RUCAM score. Conclusion : Physicians should be aware of this rare and potentially fatal adverse effect of albendazole.Öğe Comparison of patients with fulminant versus near-miss fulminant drug-induced hepatitis(Allied Acad, 2017) Bilgic, Yilmaz; Akbulut, Sami; Kutlu, Orkide; Yilmaz, Cengiz; Colak, Cemil; Deviren, Mehmet Veysi; Cagin, Yasir FurkanThis study aimed to investigate and compare clinical and laboratory properties of patients with fulminant versus near-miss fulminant drug-induced hepatitis and the effect of these properties on mortality. Drug-induced hepatitis is the most common cause of acute liver failure in western countries. In severe drug-induced hepatitis, once encephalopathy develops, prognosis is poor without liver transplantation. Therefore, it is important to predict prognosis and know the clinical differences between patients developing encephalopathy and patients without encephalopathy. Patients with severe drug-induced hepatitis were researched retrospectively. The identified patients were divided into two groups: with encephalopathy (fulminant hepatitis; 25 patients) and without encephalopathy (near-miss fulminant hepatitis; 48 patients). The clinical properties and biochemical results of the two groups were compared, and parameters that could have an effect on mortality were evaluated. Hemoglobin, platelet count, albumin, and fibrinogen levels were found to be decreased, whereas, International Normalized Ratio (INR), total bilirubin, AST, LDH, lactate, and ammonia levels were found to be increased significantly in the fulminant hepatitis group. Creatinine, Model for End-Stage Liver Disease (MELD) score, and platelet count were found to be independent risk factors on mortality. The development of hepatic encephalopathy negatively impacts patient survival. Therefore, the prediction of a progression to fulminant hepatitis before hepatic encephalopathy develops and the clinical follow-up of patients accordingly are important issues. This study can provide significant insight into patients with severe drug-induced hepatitis.Öğe Could platelet indices be prognostic biomarkers for mild or severe acute pancreatitis?(E-Century Publishing Corp, 2016) Bilgic, Yilmaz; Akbulut, Sami; Kutlu, Orkide; Colak, Cemil; Yilmaz, Cengiz; Seckin, Yuksel; Cagin, Yasir FurkanThe aim of this study was to show the relation of platelet indices with the severity of acute pancreatitis (AP) and if they have any correlation with the severity of AP. Forty-seven patients with AP hospitalized in Department of Gastroenterology, Inonu University Faculty of Medicine were divided into two groups, namely, the severe AP group (n=15) and the mild AP group (n=32). The scores of these patients at days 0, 3 and at the beginning of remission according to the prognostic scoring systems (Ranson, APACHE II, and BISAP criteria), CRP, sedimentation and platelet indices (platelet count, MPV, PDW and PCT) were noted. Mann-Whitney U test was used to compare the groups. Spearman's Rho test was used to evaluate the correlations between the platelet indices and other prognostic factors. Significant differences were found between the groups as regards platelets (P<0.02), PDW (P<0.001), AST (P<0.001), ALT (P<0.001), Total bilirubin (P<0.007), LDH (P<0.001), CRP (P<0.001), sedimentation (P<0.001), APACHE-II (P<0.001), Ranson (P<0.002) parameters. When considered for the correlation between the platelet indices and other prognostic factors, it was seen that all the platelet indices showed strong positive or negative correlation in mild AP with other prognostic scoring systems, CRP and sedimentation. In contrast, it was seen that platelet indices in severe AP cases did not show strong correlation with other prognostic scoring systems, CRP and sedimentation. We showed that platelet derivatives can be used as a good prognostic biomarker for the course of mild AP. In severe AP cases, however, usability of platelet indices must be supported with further studies.Öğe Does the tumor necrosis factor a predictor factor in patients with chronic hepatitis B and C(Allied Acad, 2017) Bilgic, Yilmaz; Seckin, Yuksel; Cagin, Yasir Furkan; Yildirim, Oguzhan; Yilmaz, Cengiz; Harputluoglu, Murat; Harputluoglu, HakanAim: In our research, we aimed to investigate the importance and pattern of Tumor Necrosis Factor (TNF) alpha in response to the combinatorial treatment of lamuvidin (LAM) and Pegile interferon (PEG INF) 2a + Ribavirin (RIB) in patients with Chronic Hepatitis B (CHB) and Chronic Hepatitis C (CHC). Material and method: Thirty four CHB and 25 CHC patient samples were taken before and after the treatment and stored appropriately. CHB patients were treated with LAM and CHC patients were treated with using the combination of PEG INF 2a and RIB. HBV DNA, anti HBe, ALT, AST and TNF alpha results were obtained from CHB patients before and 48th week of the treatment. HCV RNA, ALT, AST and TNF alpha results were also obtained from CHC patients before and in the 6th month of completing the treatment. Responses to the treatment were taken as negative result of HBV DNA in CHB patients after finishing the treatment and as negative result of HCV RNA in CHC patients after 6 months of finishing the 48 weeks of PEG INF treatment. Results: At the level of decreasing TNF-alpha in CHB patients when the group responding to the treatment compared to the group not responding to the treatment, a significant difference was observed in favor of the respondent group (p< 0.0001). At the level of decreasing TNF-alpha in CHC patients when the group responding to the treatment compared to the group not responding to the treatment, a significant difference was also obtained in favor of the respondent group (p< 0.0001). In the analysis for emphasizing the importance of TNF alpha level in response to the treatment in CHB patients, it was found that predicting the response to the treatment of TNF alpha was 78.6% sensitivity and 75% specificity for 68.78 cutoff. In the analysis for emphasizing the importance of TNF alpha level in response to the treatment in CHC patients, it was found that determining the response of TNF alpha to the treatment was 100% sensitivity and 100% specificity for 122.4 cutoff. Conclusions: With the treatment a decrease in TNF alpha is occured in CHB and CHC patients; however, TNF alpha decrease in the groups responding to the treatment is more significant. The results of this research show that TNF alpha level may be an important non-invasive marker for foresight and determining the response to the treatment.Öğe Drug induced autoimmune hepatitis: a single center experience.(Allied Acad, 2017) Bilgic, Yilmaz; Harputluoglu, Hakan; Yilmaz, Cengiz; Karadag, Nese; Cagin, Yasir Furkan; Akbulut, Sami; Seckin, YukselObjective: Many drugs such as minocycline, nitrofurantoin, halothane, non-steroidal anti-inflammatory drugs, anti TNF (Tumor Necrosis Factor) antagonists can induce the autoimmune hepatitis. Herein, we aimed to assess patients suffering from drug induced autoimmune hepatitis who were hospitalized with acute hepatitis like transaminase elevations to our clinic between 2009-2015. Method: The patients were determined using simplified diagnostic criteria of the International Autoimmune Hepatitis Group. Results: We determined 9 patients whose score were compatible with the diagnosis of Autoimmune hepatitis (AIH). Three patients were older than 50, and six patients were between 19 and 31. Seven of nine patients were female. The drugs thought responsible for AIH were as follows; ciprofloxacin alone, amoxicillin plus nimesulid, amoxicillin plus ornidazole, amoxicillin alone, a combined oral contraceptive pill plus a mixture of natural drugs, metronidazole plus dexketoprofen, ramipril plus metronidazole, levofloxacin alone and venlafaxine plus mianserin for each case. Five of nine patients had been followed up conservatively upon discontinuation of drug(s) and did not need any treatment during hospitalization and resolved spontaneously. Four patients received immunosuppressive treatment which was withdrawn in 3 of those 4 patients after 3 to 6 months upon remission without relapse. Conclusion: Drug induced autoimmune hepatitis (DIAIH) can be presented with acute hepatitis of unknown etiology. Female sex seems to be a risk factor for DIAH. Treatment decisions should be given according to patient's clinical status and follow up at acute presentations. There can be no treatment need, but, when needed generally a short course of immunosuppressive treatment can be sufficient.