Hepatitis: Tabak F

Mert A, Tabak F, Ozaras R, Ozturk R, Aki H, Aktuglu Y. · Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, University of Istanbul, 34303 Aksaray, Istanbul, Turkey. · Intern Med. · Pubmed #15206561 links to  free full text

Abstract: During the course of typhoid fever, the usual histologic finding of the liver is "nonspecific reactive hepatitis." Hepatic granuloma (HG) is a rare complication of typhoid fever. We present two cases of typhoid fever with HG and review the relevant literature. Case 1 (a 53-year-old female) was found to have both hepatic and splenic granulomas. This is the first case of typhoid fever with splenic granulomas in the English language literature. Case 2 (a 66-year-old male) developed granulomas in the bone marrow in addition to HG. It should be considered that typhoid fever may lead to granulomas in several organs.

Tabak F, Ozaras R, Erzin Y, Celik AF, Ozbay G, Senturk H. · Cerrahpasa Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Cerrahpasa, Istanbul, Turkey. · Liver Int. · Pubmed #14708896 No free full text.

Abstract: Metronidazole and ornidazole, synthetic nitroimidazole derivatives, are used in the treatment of infections caused by anaerobic bacteria and protozoa. The drugs are well tolerated and serious side effects are very rarely encountered. Hepatotoxicity is a rare side effect and hitherto only six cases have been reported. We describe three patients who developed hepatitis after ornidazole use and review the previously reported cases. All three cases used ornidazole in conventional doses and developed hepatitis and associated cholestasis. They improved 1-2 months after discontinuation. We concluded that nitroimidazole derivatives may cause hepatotoxic damage resembling acute cholestatic hepatitis. Early recognition and withdrawal of the drug may prevent further damage.

Tabak F, Mert A, Ozaras R, Biyikli M, Ozturk R, Ozbay G, Senturk H, Aktuglu Y. · Department of Clinical Bacteriology and Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Beylerbeyi 81210 Istanbul, Turkey. · J Clin Gastroenterol. · Pubmed #11960076 No free full text.

Abstract: Losartan, an angiotensin II receptor antagonist, is widely used for the treatment of hypertension. Clinical experience with this drug has demonstrated that it is safe. Losartan-induced hepatic toxicity is extremely rare. We report a case of severe hepatic toxicity and fibrosis caused by losartan use, and we review four previously reported cases. Drug-induced hepatic injury may be seen during the treatment of hypertension by losartan and the clinician should be aware of this toxicity, especially during the initial phase of treatment.

Mert A, Tabak F, Ozaras R, Tahan V, Senturk H, Ozbay G. · No affiliation provided · J Clin Gastroenterol. · Pubmed #11588555 No free full text.

This publication has no abstract.

Buster EH, Flink HJ, Cakaloglu Y, Simon K, Trojan J, Tabak F, So TM, Feinman SV, Mach T, Akarca US, Schutten M, Tielemans W, van Vuuren AJ, Hansen BE, Janssen HL. · Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. · Gastroenterology. · Pubmed #18585385 No free full text.

Abstract: BACKGROUND & AIMS: The aim of this study was to evaluate the long-term sustainability of response in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B treated with pegylated interferon (PEG-IFN) alpha-2b alone or in combination with lamivudine. METHODS: All 266 patients enrolled in the HBV99-01 study were offered participation in a long-term follow-up (LTFU) study. Patients were treated with PEG-IFN alpha-2b (100 mug/wk) alone or in combination with lamivudine (100 mg/day) for 52 weeks. Initial response was defined as HBeAg negativity at 26 weeks posttreatment. For the LTFU study, patients had one additional visit after the initial study (mean interval, 3.0 +/- 0.8 years). RESULTS: Of 266 patients enrolled in the initial study, 172 (65%) participated in the LTFU study. At LTFU, HBeAg and hepatitis B surface antigen (HBsAg) negativity were observed in 37% and 11% of 172 patients, respectively. Sixty-four patients were classified as initial responders and 108 as nonresponders. Among the initial responders, sustained HBeAg negativity and HBsAg loss were observed in 81% and 30%, respectively. Significantly higher rates of HBeAg negativity were observed in genotype A-infected initial responders compared with those with genotype non-A (96% vs 76%; P = .06) as well as HBsAg loss (58% vs 11%; P < .001). CONCLUSIONS: HBeAg loss after treatment with PEG-IFN alpha-2b alone or in combination with lamivudine is sustained in the majority of patients and is associated with a high likelihood of HBsAg loss, particularly in genotype A-infected patients. Therefore, PEG-IFN alpha-2b remains an important treatment option in this era of nucleos(t)ide analogue therapy.

Senturk H, Ersoz G, Ozaras R, Kaymakoglu S, Bozkaya H, Akdogan M, Mert A, Bozdayi M, Tabak F, Yenice N, Ozbay G. · Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. · Dig Dis Sci. · Pubmed #12822874 No free full text.

Abstract: We aimed to compare the efficacy of interferon-alpha2b (IFN) induction treatment in combination with ribavirin to IFN induction alone in chronic hepatitis C. In total, 125 patients (66 male, 59 female, mean age: 48 +/- 9, range: 21-70) were enrolled and randomized into two arms: In the first, patients received 5 MU/day of IFN for 4 weeks followed by 3 MU/day for the next 4 weeks. Treatment was continued with 3 MU three times a week IFN for an additional 40 weeks. Ribavirin was administered 1000-1200 mg/day according to the body weight for the entire 48-week period. In the second arm, patients received placebo in addition to IFN. Fifty-nine patients were placed in the ribavirin arm and 66 in placebo arm. All patients were genotype 1. At week 48, 24/66 (36%) from the placebo and 31/59 (52%) from the ribavirin group responded (P > 0.05). However, during the 24-week untreated follow-up period, 13/24 (54%) from the placebo, and 8/31 (26%) from the ribavirin group relapsed (P = 0.002.), resulting in a sustained virologic response (SVR) rate of 17% in the placebo and 39% in the ribavirin group (P = 0.005.) In conclusion, IFN induction treatment in combination with ribavirin is superior to IFN induction treatment alone in genotype 1 patients, and the SVR rate of 39% is encouraging.

Senturk H, Tabak F, Akdogan M, Erdem L, Mert A, Ozaras R, Sander E, Ozbay G, Badur S. · Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Turkey. · J Gastroenterol Hepatol. · Pubmed #11895556 No free full text.

Abstract: AIMS: The aim was to test the efficacy of a pre-S2-containing vaccine (Genhevac-B) in chronic hepatitis B (CHB). Twenty-five naive patients (22 male, three female; median age 35; range: 6-69 years) with CHB were recruited. The inclusion criteria were: hepatitis B e antigen (HBeAg) positive or HBV-DNA detectable with liquid hybridization; alanine aminotransferase (ALT) is at least 1.5-fold the upper normal limit and histological evidence of chronic hepatitis. METHODS: In the first period, all patients received monthly injections of 20, 40 and 60 microg of the vaccine. One month after the last injection, patients who still had HBV-DNA were divided into two randomly assigned groups. While the patients in the first group and the patients who lost HBV-DNA in the first period continued to receive monthly injections of 20 microg vaccine for a further 6 months, the patients in the second group received 9 MU interferon alpha-2b (Roferon-A), three times per week using the same method as for the first group. Patients were followed up after 12 months without treatment. Response was defined as the loss of HBV-DNA and normalization of ALT. RESULTS: Six of the 25 patients lost HBV-DNA after 3 months. Nine of the remainder were randomly placed in the first group (vaccine-only) and 10 were placed in the second group (vaccine + interferon). End-of-treatment response was achieved, overall, 8/15 from the vaccine group and 6/10 from the combination. One patient from each group relapsed during the follow up. Overall, the sustained response (SR) rate was 46% (7/15) in the vaccine group, and 50% (5/10) in the combination group. Histological improvement was achieved in 6/7 SR with vaccine-only and all five with combination treatment, while 1/8 of failures of vaccine and 2/5 of failures of combination improved. CONCLUSIONS: It was concluded that Genhevac-B decreases serum HBV-DNA levels in the majority of patients with CHB and sustained clearance was achieved in some patients. Combination of interferon-alpha with Genhevac-B is effective for the vaccine failures and may increase sustained response compared to interferon-alpha alone. However, the mechanism of action is yet to be explained.

Tabak F, Gunduz F, Tahan V, Tabak O, Ozaras R. · Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Cerrahpasa Medical Faculty, 34303, Istanbul, Turkey. · Dig Dis Sci. · Pubmed #18958618 No free full text.

Abstract: Sertraline is a commonly prescribed selective serotonin reuptake inhibitor drug. Hepatotoxicity caused by sertraline is rare. Asymptomatic elevations in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels have been rarely reported and shortly normalize after discontinuation of the agent. We present a case of severe drug-induced hepatitis in a patient receiving sertraline. To our knowledge, this is the seventh case in the medical literature as being associated with severe hepatotoxicity. Since it is extremely rare, we do not suggest a strict laboratory monitoring. However, sertraline should be discontinued in cases with symptoms implying hepatotoxicity and the patients should be informed of the potential of this side effect.

Tabak F, Ozdemir F, Tabak O, Erer B, Tahan V, Ozaras R. · Istanbul University, Cerrahpasa Medical Faculty, Department of Infectious Diseases. · Ann Hepatol. · Pubmed #18626439 No free full text.

Abstract: Hepatitis A virus (HAV) is the most common cause of acute viral hepatitis in the world. Rarely, acute infection may persist for a long time. Autoimmune hepatitis (AIH) may provide anti-HAV IgM positivity detection for a prolonged time. On the other hand, HAV as an infectious agent may also trigger AIH. Here we presented a case which seemed like a simple acute viral hepatitis A infection at the beginning but turned out to be an AIH according to the International Autoimmune Hepatitis Group's system. A 21-year-old female was diagnosed as symptomatic acute HAV infection with anti-HAV IgM positivity and elevated aminotransferase levels. The other viral serological tests were negative. On the 6th, 12th and 18th months of the follow up, her anti-HAV IgM positivity still continued and transaminase levels were also 3 to 7 times high of the upper limit of normal. In addition, antinuclear antibody was positive. However, on the 19th month anti-HAV IgM could be detected as negative. Liver histology was prominent. The patient had a score of 16 according to the International Autoimmune Hepatitis Group's system. She was given prednisolone (10 mg/day) and azathioprine (100 mg/day). The aminotransferase levels were detected within normal ranges at the end of the first month of therapy. She was in remission during follow up for 6 years. In conclusion, prolonged HAV infection and AIH may not only trigger each other but also deteriorate the liver histology. AIH should be investigated in cases of long-lasting HAV infection in order to begin the treatment earlier. On the other hand, AIH patients should also be vaccinated for both HBV and HAV to avoid more severe diseases.

Senturk H, Tahan V, Canbakan B, Uraz S, Ulger Y, Ozaras R, Tabak F, Mert A, Ozbay G. · Department Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. · Neth J Med. · Pubmed #18490796 links to  free full text

Abstract: BACKGROUND: The effect of conventional interferon-based therapy of hepatitis B virus (HBV) and hepatitis C virus (HCV) dual infection is controversial. Yet, no studies have been carried out into pegylated interferon treatment for chronic HBV/HCV coinfection. We aimed to evaluate the response rate and side effects of conventional or pegylated interferon combined with ribavirin on chronic HBV/HCV coinfection therapy. METHODS: The study included 36 chronic hepatitis patients (M/F: 28/8, mean age 47+/-12 years) who were positive for HBsAg and anti-HCV. They were tested for the presence of HBV-DNA by hybridisation assay, and the samples giving negative results were retested by polymerase chain reaction (PCR). All patients were tested for HCV-RNA using PCR, and the HCV genotype was determined. RESULTS: Nineteen patients were given standard interferon either alone or in combination with ribavirin, whereas 17 were given pegylated interferon and ribavirin combination therapy. None of the patients had HBV-DNA positivity; however, all had HCV-RNA detectable by PCR. All the patients had HCV genotype 1b. The mean alanine aminotransferase and aspartate aminotransferase levels were 118+/-65 U/l and 90+/-95 U/l respectively. Five patients in each group discontinued the treatment due to side effects. Only two patients (one from each group) reached sustained virological response. CONCLUSION: Neither pegylated nor conventional interferon based regimes were effective for HBV/HCV coinfection, in which the dominant virus was HCV. Pegylated interferon and ribavirin therapy was not superior to conventional interferon based regimes in the treatment of HBV/HCV coinfection.

Ozaras R, Tabak F, Tahan V, Ozturk R, Akin H, Mert A, Senturk H. · Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, 34098, Cerrahpasa, Istanbul, Turkey. · Dig Dis Sci. · Pubmed #18409002 No free full text.

Abstract: BACKGROUND AND AIM: Viral load is used for the diagnosis and monitoring the treatment of chronic hepatitis B (CHB). These methods are molecular-based and are expensive. Previous studies suggest that quantitative hepatitis B surface antigen (HBsAg) studied by automated chemiluminescent microparticle immunoassay can be a surrogate marker. In this study, we aimed to investigate whether quantitative HBsAg correlates hepatitis B virus (HBV) DNA levels during CHB treatment. METHODS: The study included 18 patients (13 male, 5 female, mean age: 33 +/- 9 years) with CHB. They were given pegylated interferon +/- lamivudine for 52 months and serum samples were obtained in weeks 0, 4, 8, 24, 48, 52, and 76. HBV DNA was measured by TaqMan polymerase chain reaction (PCR; Erasmus MC, University Medical Center, Rotterdam, The Netherlands). Quantitative HBsAg was studied by automated chemiluminescent microparticle immunoassay (Architect HBsAg, Abbott, IL). Results HBV DNA levels were measured as follows: 9.66, 7.69, 7.06, 5.93, 5.89, 5.88, and 7.27 logarithmic genome equivalent/ml, respectively. The corresponding HBsAg quantitation results were 42,888, 31,176, 37,882, 27,277, 28,279, 29,471, and 31,535 IU/ml, respectively. They showed a significant correlation (canonical correlation = 0.85). CONCLUSIONS: HBsAg studied by automated chemiluminescent microparticle immunoassay correlates with HBV DNA and can be a surrogate marker during the monitoring of the efficacy of HBV treatment.

Senturk H, Tahan V, Canbakan B, Dane F, Ulger Y, Ozaras R, Tabak F, Ozbay G. · Istanbul University Cerrahpasa Medical Faculty Department of Gastroenterology, Istanbul. · Ann Hepatol. · Pubmed #18376366 No free full text.

Abstract: There is controversial data in the literature about the characteristics or features of dual hepatitis B and C infection. Several studies have reported that the dual infection has a more severe histological picture; faster progression leading to cirrhosis and a higher risk for hepatocellular carcinoma compared with the single infections. These findings have not yet been supported. We assessed the patients with dual hepatitis B and C infection with respect to their different features in our country. METHOD: the chronic hepatitis patients of our clinics were tested, and both HBsAg and anti-HCV positive patients with chronic hepatitis were enrolled to the study. All patients were tested for the biochemical parameters and the presence of HBV-DNA and HCV-RNA. RESULTS: Of the 1950 patients, 51 (2.6%) were both HBsAg and anti-HCV positive and 67 were anti-delta positive. Patients were followed up for 5.4+/-2.1 years. Of the 51 dual hepatitis patients, 6 had no HBV-DNA and HCV-RNA detectable by PCR, 36 were only HCV-RNA positive, 9 were only HBV-DNA positive and 3 were both HBV-DNA and HCV-RNA positive. Dominant infection in (3/4) of the patients was hepatitis C. Clinical and histological properties of the cases with dual Hepatitis B and C infection showed no significant differences compared to the single infections. In conclusion, regarding the prognosis, no significant differences were found between such dual and single infections. Dual infection with hepatitis B virus and delta virus is a significantly more severe condition than the dual infection with hepatitis B and C viruses.

Canbakan B, Senturk H, Tabak F, Akdogan M, Tahan V, Mert A, Sut N, Ozaras R, Midilli K, Ozbay G. · Department of Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. · J Gastroenterol Hepatol. · Pubmed #16677149 No free full text.

Abstract: BACKGROUND AND AIM: Delta hepatitis is characterized by rapidly progressive liver disease with adverse prognosis in most patients. Patients benefit from high doses and prolonged courses of interferon (IFN) therapy; however, lamivudine as a single agent has been disappointing. Data relating to the efficacy of IFN and lamivudine in combination is limited. The aim of this study was to test the efficacy of IFN-alpha 2b and lamivudine combination treatment in comparison to IFN-alpha 2b alone in patients with chronic delta hepatitis. METHODS: Twenty-six patients with chronic delta hepatitis were randomized into two groups. Twelve patients received IFN-alpha 2b alone (eight men, four women; mean +/- SD age: 43.83 +/- 8.57 years), and 14 patients received IFN-alpha 2b plus lamivudine combination (seven men, seven women; mean +/- SD age: 42.5 +/- 11.02 years). The dose of IFN-alpha 2b was 10 MU t.i.w. and of lamivudine was 100 mg/day. The groups were comparable in reference to serum alanine aminotransferase (ALT), aspartate aminotransferase, bilirubin, albumin levels, histological activity and stage. Four patients (33.3%) in the IFN group and two (14.3%) in the combination group had cirrhosis (P = 0.2). The duration of treatment was 48 weeks with an untreated follow-up period of at least 96 weeks (mean +/- SD, 3.1 +/- 1.9 years). A liver biopsy was performed at the end of treatment. RESULTS: Eight patients from the IFN group and 11 from the combination group completed treatment. Serum ALT values became normal in 8/14 patients (57.1%) treated with IFN plus lamivudine and in 5/12 patients (41.7%) treated with IFN alone (P = 0.43). Serum hepatitis delta virus RNA was no longer detectable in nine of 14 (64.3%) patients treated with IFN plus lamivudine as compared to five of 12 (41.6%) patients treated with IFN alone (P = 0.024). In both groups female patients had significantly better virological response rate (P = 0.007). There was a significant improvement in histological activity in the combination group (mean decrease 5.27 +/- 1.08 score, P = 0.001), but not in the IFN group (mean decrease 1.44 +/- 1.59 score, P = 0.39). No significant improvement was observed in regards to fibrosis. Four of the 14 patients (28.6%) treated with combination therapy as compared to two of 12 patients treated with IFN (16.7%) were sustained virological responders (P = 0.47). The 5-year survival rate was 65% in the IFN group and 85% in the combination group (P > 0.05). CONCLUSION: Interferon and lamivudine in combination is an encouraging treatment method and may be superior to IFN alone in chronic delta hepatitis.

Yildirim B, Tahan V, Ozaras R, Aytekin H, Mert A, Tabak F, Senturk H. · Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey. · Dig Dis Sci. · Pubmed #16416188 No free full text.

Abstract: Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the worldwide. This infection is often insidious and one-half of infected patients are asymptomatic. Determination of risk factors for HCV transmission is very important. The aim of this study was to assess the risk factors, transmission to spouses and children for HCV infection in Turkish population. One hundred and fifty-one patients with chronic hepatitis C and 151 control cases were investigated for the probable risk factors of HCV infection. Complete blood count, ALT, AST, albumin, prothrombin time, upper abdomen ultrasonography assessment and percutaneous liver biopsy (not for cirrhotics) were performed in all patients with chronic hepatitis C. Anti-HCV testing was done by using second-generation ELISA in 302 cases. Minor surgical operation (p < 0.001), major surgical operation (p = 0.001), blood transfusion (p < 0.001), multi-partner sex (p < 0.05), frequent dental therapy (p < 0.05), and dental extraction (p < 0.001) in patients with a chronic HCV infection were found to be higher than the control group. No significant difference was found in other risk factors. The rate of hepatitis C virus in index cases was found to be 1.8% in their spouses and 1.2% in their children. Our study showed that surgical operation, frequent dental therapy, dental extraction, multi-partner sex, and blood transmission are the main risk factors for HCV infection in Turkish community.

Tahan V, Ozaras R, Lacevic N, Ozden E, Yemisen M, Ozdogan O, Mert A, Tabak F, Avsar E, Celikel CA, Ozbay G, Kalayci C, Senturk H, Tozun N. · Department of Gastroenterology, Marmara University, Medical Faculty. · Dig Dis Sci. · Pubmed #15573907 No free full text.

Abstract: An increasing frequency of hepatic granulomas, up to 10%, in chronic hepatitis C patients is reported, and their presence is considered to be a predictor of treatment success. However, there is only one prevalence study on granuloma in chronic hepatitis B, and its significance for treatment outcome is unknown. We aimed to determine the prevalence of hepatic granulomas in a larger group of chronic hepatitis B patients and to compare their presence with the response to interferon therapy. Biopsy specimens of chronic hepatitis B patients were reevaluated for the presence of hepatic granulomas. All patients with hepatic granuloma were screened for other granulomatous diseases by tuberculin skin test, chest X-ray and computed tomography, venereal disease research laboratory, Brucella agglutination tests, and exposure to hepatotoxic agents. We screened 663 cases of chronic hepatitis B. Hepatic granulomas were found in 10 cases (1.5%). The granulomas could not be ascribed to any other reason. Of the 10 patients with hepatic granulomas, 4 responded to interferon therapy, 2 dropped out, and 4 were nonresponders. We conclude that hepatic granuloma is a rare finding in chronic hepatitis B and its presence does not seem to predict the response to interferon therapy.

Ozaras R, Tahan V, Mert A, Uraz S, Kanat M, Tabak F, Avsar E, Ozbay G, Celikel CA, Tozun N, Senturk H. · Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. · J Clin Gastroenterol. · Pubmed #15100526 No free full text.

Abstract: OBJECTIVES: Hepatic granulomas are not usual findings in chronic hepatitis C. A few studies addressing the frequency of hepatic granulomas in chronic hepatitis C reported it as less than 10%. The presence of it has been suggested to predict a favorable response to interferon treatment. Also, case reports described the development of hepatic granulomas after interferon treatment. In this study, we aimed to detect the prevalence of hepatic granulomas in chronic hepatitis C and to identify the causes other than chronic hepatitis C, if present, to search whether there is an association between the presence of granuloma and response to interferon treatment and also to see whether interferon leads to the formation of hepatic granulomas. METHODS: Patients from 3 university clinics were included. All patients with chronic hepatitis C were determined. All patients with hepatic granulomas were screened for the other causes of hepatic granuloma with tuberculin skin test, chest X-ray and computed tomography, Venereal Disease Research Laboratory, and Brucella agglutination tests. The histologic assessment of liver biopsies was done by the same pathologist in each center. RESULTS: A total of 725 liver biopsies of 605 patients with chronic hepatitis C were screened. In 8 patients, hepatic granulomas were detected in the initial liver biopsies. Four patients had repeat biopsies, and all had hepatic granulomas again. The prevalence of hepatic granulomas in patients with chronic hepatitis C was calculated as 1.3% (8 of 605) in reference to patient population. Presence or absence of hepatic granulomas was seemingly stable. All patients with hepatic granulomas had negative results of tuberculin skin test, Venereal Disease Research Laboratory, chest X-ray and computed tomography, and Brucella agglutination tests. All repeat biopsies were obtained after interferon (+/- ribavirin) in varying doses and duration. Four of 8 patients with hepatic granulomas were found to respond interferon therapy. No patient was found to develop hepatic granulomas after interferon therapy. CONCLUSION: Hepatic granulomas are a rare finding in HCV infection. The presence of it does not seem to predict the response to interferon therapy. The development of hepatic granulomas during interferon therapy is not usual.

Ozaras R, Mert A, Yilmaz MH, Celik AD, Tabak F, Bilir M, Ozturk R. · Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, 34303 Cerrahpasa, Istanbul, Turkey. · J Clin Gastroenterol. · Pubmed #12811216 No free full text.

Abstract: Acute hepatitis A virus (HAV) infection is frequent in developing countries. Although some gallbladder abnormalities are defined during the course, an acute cholecystitis is extremely rare. We here report 2 additional cases of cholecystitis due to acute HAV infection and review the previously reported 2 cases. One of our patients was admitted with jaundice and a suspicious portal mass with a presumed diagnosis of cholagiocarcinoma. The other presented with jaundice, abdominal pain, and constitutional symptoms. Both patients were planned to be operated on. During the follow-up, absence of fever, leukocytosis, acute-phase protein response, and calculus in biliary system were against the diagnosis of a bacterial cholecystitis. Moreover the course of cholecystitis was closely parallel to that of the HAV infection. Both patients were managed conservatively. It was concluded that rare, acute viral cholecystitis can develop during the course of acute HAV infection.

Akdogan M, Senturk H, Mert A, Tabak F, Ozbay G. · Department of Gastroenterology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey. · J Gastroenterol. · Pubmed #12768389 No free full text.

Abstract: BACKGROUND: We aimed to determine the frequency of alanine aminotransferase (ALT) elevation during interferon-alpha treatment, the so-called "flare", its relation to serum beta-2 microglobulin levels, and its impact on the outcome of treatment in chronic hepatitis B. METHODS: The files of 53 treatment-naive patients with chronic hepatitis B (17 hepatitis B e antigen (HBeAg) +ve, 36 HBeAg -ve) who had been treated with 10 MU interferon-alpha 2b three times per week for 24 weeks were reviewed. We analyzed the fluctuations in serum ALT, beta(2)-microglobulin, and HBV-DNA levels before, during, and after flare. RESULTS: We detected flare in 4/17 (24%) of the HBeAg +ve and 7/34 (21%) of the HBeAg -ve patients. ALT level peaked between weeks 2 and 16 (mean, week 8). After flare, HBV-DNA disappeared in 5/7 (71%) HBeAg -ve vs 3/4 (75%) HBeAg +ve patients (all seroconverted to anti-HBe). The overall sustained response rate was 41%: 55% in the patients with flare, and 38% in those without ( P > 0.05). Basal serum beta(2)-microglobulin levels were significantly higher in responders vs nonresponders (2.19 +/- 0.32 vs 1.78 +/- 0.34 mg/l, mean +/- SD; P < 0.005). In addition, during treatment, serum beta(2)-microglobulin levels increased significantly only in responders, and the degree of increase was significantly higher in responders with flare vs responders without flare (3 +/- 0.33 vs 2.34 +/- 0.35 mg/l; P < 0.001). CONCLUSIONS: This study, with a limited sample size, showed that, in chronic hepatitis B, there is a trend for a higher response in patients with exacerbation of hepatitis B with interferon-alpha treatment. However, the difference does not reach statistical significance to be of predictive value. On the other hand, serum beta(2)-microglobulin levels before and during treatment may be useful in predicting the outcome.

Mert A, Bilir M, Ozaras R, Tabak F, Karayel T, Senturk H. · Department of Infectious Diseases, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey. · Respiration. · Pubmed #11070460 links to  free full text

Abstract: BACKGROUND: Sarcoidosis is known to be associated with defects in cellular immunity, especially in reference to T helper lymphocytes. Anergy to a tuberculin skin test is most characteristic of this disease. OBJECTIVES: To further the data on impaired immunity, we studied the antibody response to hepatitis B vaccination in patients with sarcoidosis. METHODS: Serologic markers of hepatitis B virus (HBV) (HBsAg, anti-HBs, anti-HBc) were studied in 40 patients with sarcoidosis (32 female, 8 male; mean age: 45 +/- 11 years, range: 25-66 years) with a mean duration of disease of 6 years. While all the markers were negative in 22 patients (55%), 2 had isolated anti-HBc positivity and 16 had both anti-HBc and anti-HBs antibodies. Thirty-five age- and sex-matched healthy subjects were studied as controls. Recombinant HBV vaccines (Genhevac B Pasteur, 20 microg) were administered (at 0, 1, and 6 months) to 16 of the seronegative cases and the controls and antibody titres were measured 1 month after the last dose. The tuberculin skin test was negative in all cases. RESULTS: While none of the vaccinees in the diseased group responded, the control group yielded an antibody response rate of 85. 7% (30/35), with a mean titre of 257.9 mIU/ml. CONCLUSIONS: Patients with sarcoidosis were invariably unresponsive to standard vaccination, while some of the diseased subjects had already mounted a natural antibody response, either before or after the development of the original disease. Cellular immunodeficiency in sarcoidosis could be a suitable model for studying immunological interactions between HBV and the host.

Senturk H, Mert A, Akdogan M, Tabak F, Basaran G, Turkoglu S, Ozbay G, Badur S. · Department of Internal Medicine, Cerrahpasa Medical Faculty of Istanbul University, Turkey. · Scand J Infect Dis. · Pubmed #11055673 No free full text.

Abstract: We aimed to test the efficacy of amantadine in chronic hepatitis C (CHC) patients infected with genotype b. Twenty patients completed treatment with amantadine HCl, 100 mg b.i.d., for 6 months. Non-sustained biochemical improvement was observed without loss of HCV-RNA. We conclude that amantadine monotherapy is not effective in CHC.

Ozaras R, Ipekci S, Kumbasar H, Aybar Y, Tahan V, Mert A, Ozturk R, Tabak F. · No affiliation provided · J Clin Gastroenterol. · Pubmed #18607296 No free full text.

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Ozaras R, Celik AD, Kisacik B, Mert A, Aki H, Ozturk R, Tabak F. · No affiliation provided · J Clin Gastroenterol. · Pubmed #12811220 No free full text.

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Engin B, Oguz O, Mert A, Ozaras R, Tabak F, Senturk H. · No affiliation provided · J Dermatol. · Pubmed #12184649 No free full text.

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Tahan V, Ozaras R, Uzunismail H, Mert A, Tabak F, Ozturk R, Aktuglu Y, Ozbay G. · No affiliation provided · J Clin Gastroenterol. · Pubmed #11418805 No free full text.

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Mert A, Tabak F, Ozturk R, Aktuglu Y, Ozaras R, Kanat M. · No affiliation provided · J Clin Gastroenterol. · Pubmed #11319332 No free full text.

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