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    Brucellosis as a rare cause of granulomatous hepatitis with hepatic and bone marrow granulomas: A case report
    (Kare Publ, 2021) Yalcin, Kendal; Tuncel, Elif Tugba; Ucmak, Feyzullah; Bestas, Remzi
    Brucellosis is a zoonotic infection that may involve the liver in a variety of ways, however, data on the histopathology of liver effects in brucellosis are limited. Brucellosis is generally characterized by a high fever, joint or back pain, and hepatosplenomegaly. This report illustrates a case of granulomatous hepatitis with granulomas in the liver and bone marrow in a patient who presented with non-specific symptoms, hepatomegaly, splenomegaly, digital clubbing, and laboratory signs of intrahepatic cholestasis. Granulomas were detected in the bone marrow and hepatic specimens. The diagnosis of brucellosis was based on the isolation of Brucella mellitensis in a blood culture and serum agglutination titers of 1:640. Treatment for brucellosis led to improved laboratory and clinical findings. Brucellosis should be considered in regions where it is endemic in cases of an elevated transaminase level and related clinical findings. Brucellosis should also be considered in the differential diagnosis of intrahepatic cholestasis and/ or granulomas in hepatic and bone marrow biopsies. This case report provides valuable histopathological features and detailed information of liver involvement in a case of brucellosis.
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    Development of hepatocellular carcinoma in patients with chronic hepatitis C who had sustained viral response following direct-acting antiviral therapy
    (Kare Publ, 2022) Ebik, Berat; Aygan, Mustafa; Tuncel, Elif Tugba; Kacmaz, Huseyin; Ekin, Nazim; Arpa, Medeni; Yalcin, Kendal
    Background and Aim: Several studies have suggested that treatment with direct-acting antivirals (DAAs) in patients with chronic hepatitis C virus (HCV) may be associated with an increased risk of developing hepatocellular carcinoma (HCC). We investigated the incidence and risk factors of HCC in HCV patients who achieved a sustained virologic response (SVR) following DAA therapies. Materials and Methods: The medical data of patients who were diagnosed with HCV and received DAA therapy in two tertiary centers in Turkey were retrospectively collected. Results: Among them, 75 patients (52.4%) were noncirrhotic and 68 patients (47.6%) were cirrhotic. The overall SVR rate was 97.2% (139/143). It was 100% in noncirrhotic and 94.1% in cirrhotic patients. HCC was developed in 5 (7.4%) patients, all of whom had baseline cirrhosis. The annual rate of HCC occurrence was 2.94%, and the 5-year cumulative incidence of HCC was 7.3%. The mean Child-Pugh score (CPS) and Model for End-Stage Liver Disease (MELD) score significantly decreased after DAA treatment (CPS 7.0 vs 5.9, p=0.001; MELD 10.8 vs 9.5, =-0.003). Conclusion: There was no significant increase in the rate of HCC in cirrhotic HCV patients treated with DAAs. This treatment led to a remarkably high SVR rate and lowered CPS and MELD scores in cirrhotic HCV patients.
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    Latest updates on chronic delta hepatitis
    (Marmara Univ, Fac Medicine, 2016) Yalcin, Kendal; Tuncel, Elif Tugba; Gunduz, Feyza
    The hepatitis D virus was shown for the first time in 1977 by Rizzetto and friends. The HDV genome and the cloning of sequence were made in 1986. HDV is the first animal virus with circular RNA genome which is seen only in plant viruses. HDV is an RNA virus with the known smallest viral genome in animal viruses. It is classified as Deltavirus genius depending on the type of virus by ICTV in 1996. HDV is classified as the sole example of delta virus in this genus. Chronic delta hepatitis is the least common form of chronic viral hepatitis due to hepatotropic viruses. In contrast, the virus is highly pathogenic and can cause serious consequences. Today, prevalance of delta hepatitis has been shown to decrease. However, the delta hepatitis continues to be an important health problem in some parts of the world. In our country, especially in Eastern and Southeastern Anatolia, hepatitis D is a serious and important health problem and still maintains its importance as a health problem. In Turkey, still there is a significant number of patients with HDV infection despite a documented decrease in HDV infection. The recommended treatment for chronic HDV infection in the current guidelines is the treatment with peginterferon alfa given once a week for 48 weeks. Treatment is indicated for patients who has compensated disease with active infection. In patients with advanced form of disease, the expected benefits of the peginterferon must be well balanced against the potential side effects and low response rate. An oral antiviral can be recommended in patients who has high levels of serum HBV DNA. In contrast, the control of HBV infecion does not seem to change the natural history of HDV related disease.
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    THE STATUS OF OXIDATIVE STRESS AND ANTIOXIDANT DEFENSE IN PATIENTS WITH CHRONIC HEPATITIS D
    (Carbone Editore, 2016) Ucmak, Feyzullah; Solmaz, Ihsan; Ekin, Nazim; Kaplan, Ibrahim; Tuncel, Elif Tugba; Senates, Ebubekir; Yalcin, Kendal
    Introduction: Oxidative stress is increasingly recognized as an important factor in the progression of chronic liver disease of varying etiologies and antioxidants are utilized in the treatment of some of them. Chronic viral hepatitis D continues to be a significant health problem in certain regions of the world. Rates of response to currently proposed treatments are rather low. The aim of this study was to investigate oxidative stress in patients with chronic viral hepatitis D. Materials and methods: A total of 91 patients with chronic hepatitis D virus infection were included in this study (mean age: 42.2 +/- 11.7). In addition, 40 healthy volunteers were included in the study to form the control group. Patients were divided into two main sub-groups as cirrhotic (n=30) and non-cirrhotic (n=61) groups. Blood samples were taken from both patients and control subjects and compared for total oxidant status (TOS), total anti-oxidant status (TAS) and oxidative stress index (OSI). Results: TOS levels were significantly higher in the patients compared to the control sub-jects (p<0.001). Moreover, TOS levels were higher in the cirrhotic patients compared to the non-cirrhotic patients (p=0.006). TAS levels were significantly lower in the patients compared to the control subjects (p=0.003). OSI levels were significantly higher in the patients compared to the control subjects (p<0.001). Moreover, OSI levels were higher in the cirrhotic patients compared to the non-cirrhotic patients (p<0.05). Conclusion: These results are supportive of the role of oxidative stress in the pathogenesis of chronic viral hepatitis D. Antioxidant therapies might be considered in patients with chronic viral hepatitis D considering the presence of oxidative stress in these patients.