RETINOPATHY CAUSING BLINDNESS IN A PATIENT WİTH DELTA HEPATITIS DURING HIGH DOSE INTERFERON ALFA-2 B TREATMENT: CASE REPORT

İnterferon (İNF) kronik hepatit B, C, metastatik renal karsinom, kutanöz melanom, kaposi sarkomu ve yeni doğanlardaki hemanjiomlarda kullanılan antiviral, antiproliferatif ve immünomodülatuar aktiviteyi düzenleyen bir ilaçtır. İNF alan hastalarda retinopati gelişme insidansı %18-86 arasındadır. Retinopati gelişmesi için başlıca risk faktörleri yüksek doz INF tedavisi, diabetes mellitus ve hipertansiyondur. INF tedavisine bağlı gelişmiş retinopati genellikle iyi seyirlidir, görme kaybı ve diğer göz semptomlarına yol açmaz. Fakat bizim olgumuzda retinopati büyük bir görme kaybına yol açmış ve 3 aylık takip sonrasında düzelmemiştir. Makalemizde 56 yaşında, erkek, delta hepatiti nedeniyle yüksek doz interferon-alfa 2b tedavisi (Haftada 3 gün 10 milyon ünite) sırasında 17. ayda retinopati gelişen hastamızı sunduk. Sonuç olarak; retinopati İNF tedavisi süresince gelişebilen akılda olması gereken bir komplikasyondur. Özellikle, yüksek risk grubundaki hastalar İNF tedavisi öncesinde mevcut olabilecek retinopati açısından değerlendirilmeli ve tedavi süresince retinopati gelişimi riski açısından üç aylık aralıklarla düzenli takip edilmelidir. Interferon (İNF) is an agent that is used in chronic hepatitis B, C, metastatic renal carcinoma, cutaneous melanoma, kaposi sarcoma and hemangiomas of infancy and has antiviral, antiproliferative and immunomodulatory activity. The incidence of retinopathy in the patients associated with interferon therapy is between 18-86%. The main risk factors for developing retinopathy are high dose INF treatment, diabetes mellitus and hypertension. Retinopathy caused by INF treatment has good prognose and does not cause blindness or other symptoms of eye. But in our patient retinopathy caused blindness and did not resolve in the follow ups for 3 months . In our article we presented, a 56 years-old, male patient with delta hepatitis, who has retinopathy that is associated with high dose interferon alfa-2 b treatment (3 x 10.000 Million Ü per week) at seventeeth month of treatment. Finally, retinopathy is a complication that must be considered during treatment with interferon. Especially, high risk patients must be evaluated before interferon therapy for the preexisting retinopathy and should be monitored in every three months for the risk of retinopathy throughout the therapy

Successful Treatment of Herpes Esophagitis With Ganciclovir in a Liver Transplant Patient

The presence of Herpes Simplex Virüs-1 (HSV-1) esophagitis in patients with liver transplantation has been reported rarely. Among the reports that are accessible in the literature, none could have shown tissue positivity for Herpes virus-1 DNA via Polymerase Chain Reaction (PCR) in patients with liver transplantation. This case is presented as the patient was diagnosed with herpes esophagitis based on the histopathological findings and HSV-1 DNA positivity (detected by PCR) in the biopsy material and was treated with Ganciclovir. Due to the specific action of Ganciclovir against CMV infections, it is natural that the drug cannot use in the treatment of HSV infections. However it is reported that ganciclovir has been reduced the incidence of symptomatic HSV infections after liver transplantation. We report on a patient after liver transplantation with HSV-1 esophagitis, who was successfully treated with Ganciclovir. We assume that most transplant centers according to their protocols use ganciclovir for CMV prophylaxis, which may contribute to avoid HSV infection

EDTA INDUCED PSEUDOTHROMBOCYTOPENIA IN A PATIENT WITH HEPATITIS A INFECTION

Pseudotrombositopeni kanama riskinde artışa neden olmayan ve trombosit transfüzyonu gerektirmeyen bir iyatrojenik laboratuar fenomenidir. Etilendiaminotetraasetik asid'e (EDTA) bağlı pseudotrombositopeni, otomatik kan sayımında yalancı olarak trombosit sayısındaki azalmayı tanımlamaktadır. Kan örneklerinin EDTA ile antikoagule edilmesi sonucunda normal kişilerde oluşabileceği gibi farklı hastalıkların seyrinde de gözlenebilmektedir. Bu yazıda hepatit A infeksiyonu seyrinde gözlenen bir EDTA bağımlı pseudotrombositopeni olgusu sunulmuştur. Olgu halen devam eden pseudotrombositopeni nedeniyle izlenmektedir. Pseudothrombocytopenia is an iatrogenic laboratory phenomenon that does not increase the risk of bleeding or the need for platelet transfusion. The term ethylenediaminotetraacetic acid (EDTA) induced pseudothrombocytopenia, defines false low platelet count when measured with automatic counters. It may occur in both normal individuals and patients with a variety of diseases when their blood samples are anticoagulated with EDTA. Here we report a patient with EDTA induced pseudothrombocytopenia during the course of hepatitis A infection. The patient is still being followed up with pseudothrombocytopenia

Evaluation of colon mucosa using screening colonoscopy and flexible spectral imaging color enhancement in patients with long lasting ulcerative colitis

Aim To determine which flexible spectral imaging color enhancement (FICE) channel best visualizes colon mucosa in ulcerative colitis (UC) and to compare FICE imaging with standard imaging. Methods The study enrolled patients with ulcerative coli - tis in remission who had inflammatory bowel disease for at least 8 years. All patients underwent screening colonos - copy. The entire colon, especially the suspicious areas in terms of dysplasia, were imaged with standard endosco - py and FICE. Random and target biopsies were obtained. Histopathological diagnosis was made and image patterns were evaluated. Seven endoscopists evaluated normal, colitis, and polyp images obtained with FICE. Results One hundred and twenty-three colon segments were evaluated and 1831 images were obtained from 18 patients. A total of 1652 images were FICE and 179 were standard images. Separate FICE images were obtained for normal colon mucosa, polypoid lesions, and colitis areas. Normal colon mucosa was best visualized using the sec - ond, sixth, and ninth FICE channel; polyps using the third, seventh, and ninth channel; and colitis using the second, third, and ninth channel. When all images were analyzed, the second and ninth channel were significantly bet - ter than the other channels. A total of 584 biopsies were obtained, including 492 (84.2%) random biopsies and 92 (15.7%) target biopsies. Random biopsies detected no dys - plasia, but target biopsies detected low-grade dysplasia in three diminutive polyps. Conclusion FICE was not significantly better at dysplasia screening than the standard procedure, but it effectively detected diminutive polyps and evaluated surface pat - terns without using magnification. FICE might contribute to the assessment of inflammation severity in patients with UC in clinical remission. However, more extensive studies are necessary to confirm these finding

Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL