Mehmet Dagli

Autoimmune hepatitis-primary biliary cirrhosis overlap syndrome concomitant with immune hemolytic anemia and immune thrombocytopenic purpura (Evans syndrome).

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.

Evaluation of bone mineral density (BMD) and indicators of bone turnover in patients with hemophilia

A decrease in bone mass is observed in hemophilic patients. The aim of this study was to evaluate bone mineral density (BMD), parathyroid hormone (PTH), 25-hydroxy vitamin D (vitamin D), and a bone formation and resorption marker, procollagen type I N-terminal propeptide (PINP) and urinary N-terminal telopeptide (uNTX) respectively, in hemophilic patients and healthy controls. Laboratory parameters related to the pathogenesis of bone loss such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were also evaluated. Thirty-five men over 18 years of age, with severe hemophilia (A and B) and receiving secondary prophylaxis, were included in the study. The same number of age-, sex-, and ethnicity-matched healthy controls were evaluated. Anthropometric, biochemical, and hormonal parameters were determined in both groups. No significant difference in anthropometric parameters was found between the two groups. The BMD was low in 34% of hemophilic patients. Vitamin D, calcium, and free testosterone levels were significantly lower (p < 0.001, p = 0.011, p < 0.001, respectively), while PTH, PINP, and activated partial thromboplastin time (aPTT) levels were significantly higher (p < 0.014, p = 0.043, p < 0.001, respectively), in hemophilic patients compared to controls. There was no significant difference between the two groups in NLR, PLR, phosphorus, thyroid-stimulating hormone, and uNTX level. The reduction of bone mass in hemophilic patients may be evaluated using the markers of bone formation and resorption, enabling early detection and timely treatment.

Serum Prohepcidin And Hepcidin Levels in Patients with Ankylosing Spondylitis: A Prospective Study

Background: Anemia is a common complication in patients with inflammatory diseases such as ankylosing spondylitis. Recent data suggest that hepcidin is a major mediator of anemia with a central role in iron homeostasis and metabolism. Objective; The aim of this study was to evaluate the serum levels of hepcidin and its prohormone, prohepcidin, in patients with ankylosing spondylitis in comparison with healthy controls. Methods: Forty patients with ankylosing spondylitis (13 with anemia and 27 without anemia), 20 healthy adults (HA) were prospectively enrolled. Complete blood count, erythrocyte sedimentation rate serum hepcidin, prohepcidin, iron, total iron binding capacity, ferritin, transferring and C-reactive protein levels were measured. Results: Serum prohepcidin and hepcidin levels were significantly higher in patients with ankylosing spondylitis compared with both healthy controls. (p<0.005). In patients with ankylosing spondylitis, positive correlation was determined between the serum hepcidin and prohepcidin levels (respectively;185±44, 73±7, p<0.05). Conclusions: To the best of our knowledge, this is the first report of serum prohepcidin and hepcidin levels in the patients with ankylosing spondylitis. Serum prohepcidin and hepcidin levels are closely associated with disease activity in patients with ankylosing spondylitis and might play a role in the pathogenesis of anemia of chronic disease associated with ankylosing spondylitis.

A fuzzy expert system design for iron deficiency anemia

In this study, an application of fuzzy expert system was introduced. This system was designed to determine the level of iron deficiency anemia and thus, expert physicians were provided with a system to assist them to determine an exact diagnosis prior to their treatment. While realizing the system design, the laboratory records obtained from real patients were examined, the appropriate parameters were specified, the input and output parameters were fuzzified and finally the rule base was built with the expert physician. This study used the centroid defuzzification method together with the Mamdani inference mechanism which is often used in the related literature. With the help of a visual programming language, the level of the disease was displayed in a perceptible way as the result of running the system.