Ali Shorbagi

Hemostatic Efficacy of Ankaferd Blood Stopper® in a Swine Bleeding Model

Objective: The purpose of this study was to show the hemostatic effect of spray, solution and tampon forms of Ankaferd Blood Stopper® (ABS), a unique medicinal plant extract historically used as a hemostatic agent in Turkish folklore medicine, in a porcine bleeding model. Materials and Methods: Two 1-year-old pigs were used as bleeding models for superficial and deep skin lacerations, grade II liver and spleen injuries, grade II saphenous vein injury and grade IV saphenous artery injury. Spray, solution or tampon forms of ABS were applied after continuing bleeding was confirmed. The primary outcome was time to hemostasis. Volume of blood loss was not measured. The pigs were euthanized at the end of the experiment. Results: Spray or direct application of ABS solution resulted in instant control of bleeding in superficial and deep skin lacerations as well as puncture wounds of the liver. A 40-second application of ABS tampon was sufficient to stop bleeding of skin lacerations, while 1.5- and 3.5-min applications were used to control hemorrhage from the saphenous vein and artery, respectively. No rebleeding was observed once hemostasis was achieved. However, repeated applications of ABS solution and tampon were only temporarily effective in the hemostasis of spleen injury. Conclusions: The data showed that ABS was an effective hemostatic agent for superficial and deep skin lacerations and minor/moderate trauma injuries in a porcine bleeding model.

Endoscopic topical application of Ankaferd Blood Stopper for neoplastic gastrointestinal bleeding: A retrospective analysis

AIM The aim of this study was to retrospectively assess the haemostatic efficacy of the endoscopic topical use of Ankaferd Blood Stopper (ABS) in the setting of neoplastic GI bleeding. METHODS The records of 10 patients with neoplastic GI bleeding (7 gastric, 3 rectal) were evaluated retrospectively. Written informed consent regarding the off-label use of ABS as a means of attaining haemostasis had been obtained from all of the patients prior to the procedure. In all patients, ABS was applied topically. Rates of bleeding control and post-procedural complications were documented. RESULTS Haemostasis was achieved in all patients within seconds of endoscopic application of ABS, with no immediate complications. Seven patients underwent subsequent cancer surgery after a bleeding-free post-procedural period. CONCLUSIONS ABS as a novel haemostatic agent could have a potential benefit in controlling bleeding from GI tumours. Prospective controlled studies are needed to help establish its efficacy, and perhaps offer a comparison to conventional haemostatic interventions.

Oral Systemic Administration of Ankaferd Blood Stopper Has No Short-Term Toxicity in an In Vivo Rabbit Experimental Model

Background: Ankaferd blood stopper (ABS) is a standardized herbal extract obtained from 5 different plants. In Turkey, it has been approved for local topical applications in external postsurgical and postdental surgery bleedings. Ankaferd blood stopper, besides its hemostatic activity, has in vitro anti-infectious and antineoplastic actions. Objective: The aim of this study was to assess short-term hematological and biochemical safety following the oral systemic administration of ABS to rabbits. Methods: Twelve rabbits (aged 6-12 months) were included to test the safety of oral ABS. Animals were divided into 4 groups, which had ABS administered orally at doses of 1, 3, 6, and 9 mL, irrespective of their weight. The general well-being and feeding patterns of the animals were observed for a period of 7 days. Blood samples (5.5 mL) were obtained just before oral administration, on days 1 and 4. Results: During the observation period of 7 days, none of the animals showed any abnormal behavior or deviation from the normal. Acute mucosal toxicity, hematotoxicity, hepatotoxicity, nephrotoxicity, and biochemical toxicity were not observed during the short-term follow-up of the animals. Conclusions: No signs of toxicity were observed in rabbits during short-term study with oral ABS administration.

Topical Ankaferd Blood Stopper Administration to Bleeding Gastrointestinal Carcinomas Decreases Tumor Vascularization

Topical Ankaferd Blood Stopper Administration to Bleeding Gastrointestinal Carcinomas Decreases Tumor Vascularization

Capecitabine-Induced Severe Hypertriglyceridemia: Report of Two Cases

Objective: To report 2 cases of severe hypertriglyceridemia associated with the use of oral capecitabine. Case Summaries: The first patient was a 73-year-old woman with metastatic breast carcinoma who received capecitabine 2500 mg/m2/day in 2 divided doses for 2 weeks followed by a one week rest period. The baseline triglyceride level was 324 mg/dL; after 2 cycles of capecitabine, levels increased to 916 mg/dL. Although lipid-lowering treatment was initiated, triglyceride levels peaked at 1782 mg/dL by the end of the seventh cycle. Eight weeks after capecitabine treatment was stopped, triglyceride levels decreased to 118 mg/dL. The second patient was a 59-year-old man with metastatic colorectal carcinoma who was placed on capecitabine treatment at a dosage of 2500 mg/m2/day in 2 divided doses for 2 weeks followed by a one week rest period. The baseline triglyceride level was 244 mg/dL; levels peaked at 1455 mg/dL at the end of the fifth cycle. Capecitabine treatment was discontinued due to disease progression, and triglyceride levels decreased to 154 mg/dL after 11 weeks. Discussion: The most frequently reported adverse effects of capecitabine are gastrointestinal and hematologic effects and palmar-plantar erythrodysesthesia. Drug-induced hyperlipidemia may appear more readily in individuals with hereditary lipoprotein lipase deficiency because decreased lipoprotein lipase activity might make these individuals more susceptible to a rise in triglyceride levels. The Naranjo probability scale indicated a probable relationship between capecitabine and severe hypertriglyceridemia. Conclusions: Capecitabine should be prescribed with care, especially in patients with preexisting hypertriglyceridemia. The question of whether capecitabine actually causes hypertriglyceridemia needs careful consideration, and the possible mechanism by which it may cause this adverse effect requires further investigation.

JAK2V617F Mutation in Patients with Portal Vein Thrombosis

In a retrospective cohort, we investigated the presence of the JAK2V617F mutation in chronic non-cirrhotic portal vein thrombosis (PVT) patients, irrespective of the presence or absence of myeloproliferative diseases (MPDs). We identified 25 patients in whom thrombophilia workup was completed. The diagnoses of MPDs were made according to the World Health Organization (WHO) criteria. JAK2V617F mutation analysis was performed by allele-specific polymerase chain reaction (PCR). There were 9 male and 16 female patients. Prior to JAK2V617F analysis, there were one or more thrombophilic risk factors in 19 patients (76%). The JAK2V617F mutation analysis revealed the presence of this mutation (all in the heterozygote state) in six patients (24%; two male, four female). Five of the six cases with prior clinical diagnosis of MPDs were found to have wild-type JAK2. We found that the addition of JAK2V617F analysis into the thrombophilia workup in patients with chronic PVT contributes to a 4% increase in the diagnosis of thrombophilic conditions.

A novel fungal pathogen under the spotlight –Acremonium spp. associated fungaemia in an immunocompetent host

Acremonium spp. are filamentous, cosmopolitan fungi frequently isolated from plant debris and soil, they are known to result in invasive infections in the setting of severe immunosuppression. In this letter, we present a case of catheter‐related fungaemia associated with Acremonium spp. in a patient with chronic renal failure. After removal of the subclavian catheter, the patient was treated successfully with voriconazole, with a loading dose of 400 mg followed by a maintenance dose of 200 mg bid. To the best of our knowledge, this is the first paper reporting Acremonium spp. associated fungaemia in a relatively immunocompetent host. We also discuss the diagnosis and treatment of Acremonium spp. associated infections in the context of current literature.

Evidence for Higher Red Blood Cell Mass in Persons With Unconjugated Hyperbilirubinemia and Gilbert’s Syndrome

Background:The genetic polymorphism responsible from Gilbert’s syndrome is not sufficient for the clinical phenotype to occur in many persons. Additional factors are believed to contribute in pathogenesis. Red cell mass may be such a factor. Methods:We have retrospectively evaluated computer records of all liver function tests assayed between January 2005 and February 2006. The database was screened to find cases with unconjugated hyperbilirubinemia and normal liver enzymes and blood count values on simultaneous assays. The control group for comparison of surrogate markers of total red cell mass comprised of age- and gender-matched persons who had laboratory tests with completely normal results on the same day with the hyperbilirubinemic cases. Gilbert’s syndrome cases were found with medical record assessment, and these cases and their control subjects were more strictly assessed. Three different control groups were established for Gilbert’s syndrome cases, one of them including healthy blood donors and personnel. Results:In 48,516 otherwise normal laboratory test results, we have found that 491 male subjects and 323 female subjects with unconjugated hyperbilirubinemia had higher hemoglobin, hematocrit, and red blood cell values compared with age- and gender-matched control subjects (P < 0.001 for all comparisons). Twenty-six males who had been followed for Gilbert’s syndrome also showed higher hemoglobin, hematocrit and red cell count values in comparison to all control groups. Mean red cell volume value did not differ between the hyperbilirubinemic persons and control groups. Conclusions:Relatively increased red cell mass probably plays a role in the pathogenesis of Gilbert’s syndrome.

Acute pericarditis and renal failure complicating acute hepatitis A infection

Hepatitis A infection may result in acute hepatitis, and rarely, fulminant hepatitis may ensue. Extrahepatic manifestations of hepatitis A are uncommon. The authors present the case of a 77-year-old male who had development of acute renal failure and pericarditis during the clinical course of acute hepatitis A infection. He died as a result of septic shock on the fifth day of hospitalization. To the best of our knowledge, this is the first report of both these rare and serious complications appearing in the same patient.

Is there an Alternative to TIPS? Ultrasound-guided Direct Intrahepatic Portosystemic Shunt Placement in Budd-Chiari Syndrome

Budd-Chiari syndrome is a spectrum of manifestations which develops as a result of hepatic venous outflow obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive vascular and interventional radiological procedure indicated in the management of refractory ascites in such patients. Conventional TIPS requires the presence of a patent hepatic vein and reasonable accessibility to the portal vein, and in patients with totally occluded hepatic veins, this procedure is technically challenging. Direct intrahepatic portosystemic shunt (DIPS) or so called “percutaneous TIPS” involves ultrasound-guided percutaneous simultaneous puncture of the portal vein and inferior vena cava followed by introduction of a guidewire through the portal vein into the inferior vena cava, as a deviation from conventional TIPS. Described here is our experience with DIPS. Three patients with BCS who had refractory ascites but were unsuitable for conventional TIPS due to occlusion of the hepatic veins were chosen to undergo the DIPS procedure. Our technical success was 100%. The shunts placed in two patients remain patent to date, while the shunt in a third patient with underlying antiphospholipid syndrome was occluded a month after the procedure. The percutaneous TIPS procedure seems to be technically feasible and effective in the management of refractory ascites as a result of BCS, particularly in the setting of occluded hepatic veins.