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    Autoimmune hepatitis-primary biliary cirrhosis overlap syndrome concomitant with immune hemolytic anemia and immune thrombocytopenic purpura (Evans syndrome)
    (ELSEVIER MASSON, CORPORATION OFFICE, 2013) Korkmaz, Huseyin; Bugdaci, Mehmet Sait; Temel, Tuncer; Dagli, Mehmet; Karabagli, Pinar
    Autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) associated with Evans syndrome; combination of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP) has rarely been reported. We report the case of a 53-year-old patient who presented with weakness, myalgia, arthralgia, shortness of breath and purpura. Initial laboratory investigations revealed liver dysfunction, anemia and thrombocytopenia. Anti-nuclear (ANA) and antimitochondrial M2 (AMA M2) antibodies were positive. Diagnose of PBC-AIH overlap was made by clinical, serological and histological investigations. AIHA and ITP was identified with clinical-laboratory findings and bone marrow puncture. She was treated with IVIG followed by prednisolone and ursodeoxycholic acid. Hemoglobin-thrombocytes increased rapidly and transaminases improved at day 8. We have reported the first case in the literature with AIH-PBC overlap syndrome concurrent by ITP and AIHA which suggest the presence of shared genetic susceptibility factors in multiple autoimmune conditions including AIH, PBC, ITP and AIHA. (C) 2012 Elsevier Masson SAS. All rights reserved.
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    Routinely evaluated clinical assays and laboratory tests [real test] and fibrosis stages of chronic hepatitis B and C
    (AVES, 2014) Bugdaci, Mehmet Sait; Korkmaz, Huseyin; Demir, Ali; Biyik, Murat; Temel, Tuncer; Gokturk, Huseyin Savas; Ozakyol, Aysegul
    Background/Aims: To provide a new mathematical formula to predict liver fibrosis in patients with chronic viral hepatitis. Materials and Methods: Patients with chronic hepatitis B and C who underwent liver biopsy at different centers were included in this study. Chronic hepatitis B was defined as immunopositivity for the hepatitis B surface antigen for at least 6 months, and chronic hepatitis C was defined as positivity for HCV RNA for at least 3 months. The histological features were evaluated by the histological activity index and fibrosis. Results: In total, 1299 patients were included in the study. The distribution and the mean of the parameters of the patients were as follows: 1009 patients with chronic hepatitis B with a mean age of 45 +/- 13/years [emale/male (F/M)=47.5/52.5%] and 290 patients with hepatitis C with a mean age of 52 +/- 10.3/years [F/M=61/39%]. When the cut-off value of the REAL TEST formula"[(age x pT x AST)/(PLT/1000)]/100" in patients with hepatitis B was determined to be >= 1.37, it was found that it could predict fibrosis with 79% specificity, 78% sensitivity, 85% negative predictive value (NPV), and 70% positive predictive value (PPV) (area under the curve (AUC)=0.852, 95% CI: 0.82-0.87). When the cut-off value of the REAL TEST formula in patients with hepatitis C was determined to be >= 1.99, it was found that it could predict significant fibrosis with 87% specificity, 90% sensitivity, 94.4% NPV, and 79.4% PPV (AUC: 0.95, 95% CI: 0.93-0.98) Conclusion: The REAL TEST formula results correlated with the pathological findings and may be a useful method for the evaluation of patients with chronic hepatitis B and C.