ABSTRACT
The present study has aimed at evaluation of serum hyaluronic acid [HA], and matrix metdloproteinase-2 [MMP-2], as a possible markers of Liver fibrosis, and their association, if any, with other clinical parameters in patients with chronic viral hepatitis. The study included 60 patients with chronic viral hepatitis and 15 normal healthy subjects of matched age and sex as a control group. Detailed history taking, complete clinical examination as well as routine investigations including complete blood picture, liver function tests [serum albumin, bilirubin, AST , ALT, and prothrombin activity], serological tests for HBV, and HCV, serum creatinine, abdominal ultrasonography, and liver histology [so long as there was no contraindication, and after a written consent from those who accept the maneuver], in addition to serum hyaluronic acid [HA], and matrix metalloproteinase [MMP-2] were all undertaken. The study revealed that: both HA and MMP-2 levels were significantly higher in patients [non-cirrhotic or cirrhotic] than the control [P<0.001]. Moreover, their levels exhibited a linear increase with the grade of liver inflammation from the minimal t-o the moderate grade [P<0.001]. In addition, they showed a linear elevation with the progression of the stage of hepatic fibrosis [P<0.001]. Only serum MMP-2 levels were significantly elevated with the deterioration of the Child-Paugh class however, the differences between A and C and Band C were significant [P=0.004, 0.001 respectively]. Both HA and MMP-2 were positively correlated with each other and with serum bilirubin [P<0.001]. They were also negatively correlated with serum albumin [P<0.001] prothrombin and time [P<0.001], and platelet count [P>0.001]. However, they were not correlated with either SGOT or SGPT. It could be concluded that; serum HA and MMP-2 levels were found, not only to be elevated in chronic viral hepatitis than the control, but they became also markedly increased when cirrhosis supervenes. In addition, these markers exhibited a linear elevation with the progression of both the grade of inflammation and the stage of hepatic fibrosis. Thus, they might be considered as an alternative to liver biopsy for assessment of the extent of hepatic fibrosis especially if the biopsy is contraindicated
ABSTRACT
Nitric oxide [No] is a messenger molecule involved in pathogen suppression. Liver cirrhosis is characterized by an increased risk for infections, including Spontaneous Bacterial Peritonitis [SBP]. The role of NO in infections that develop in cirrhosis has not been fully investigated. The present study has aimed at investigation of the status of serum and ascites NO in cirrhotic patients with and without SBP and its relation, if any, with the parameters of liver function. The study was carried out on 56 patients suffering from liver cirrhosis and ascites with and without SBP. Their ages ranging from 35-70 years [mean 53.55 +/- 9.5yeat-s]. Thorough history taking, complete clinical examination, and routine investigations including complete blood picture, serum creatinine, liver function tests [serum albumin, bilirubin, SGOT, SGPT and prothrombin activity], hepatitis B surface antigen, Hepatitis C antibodies, blood culture, ascetic fluid cytology and culture for aerobic organisms, anaerobic organisms, and culture for rare organisms, besides serum and ascites NO assay, were all undertaken. The study revealed a significant elevation of serum and ascites NO in SBP groups than non-SBP group [P=0.009, 0.001, 0.0001 -0.001, 0.003, and 0.001]. Moreover, their levels have been reduced significantly after treatment of SBP [P=0.0001, 0.0001, 0.0001, -0.0.009, 0.04, and 0.001 respectively]. Although, serum NO showed no correlation with serum bilirubin, albumin, or prothrombin activity, it was found to be positively correlated with the Child-Pugh class of the studied patients [P0.045, 0.013, 0.001, and 0.045 respectively], however, ascites NO was not. In addition, ascites NO level was not correlated with any of the laboratory parameters of acetic fluid among the studied patients. The present study have shown also that; serum and ascites NO levels were found to be significantly higher in SBP patients with functional renal failure than those without. It is to be noted that; serum and ascites NO were correlated with each other [P = 0.045, 0.005, 0.004, respectively]. It can be concluded that; both serum and ascites NO level exhibited a significant elevation in cirrhotic patients especially those with SBP. Rather, ascites NO levels reflect serum levels, being higher in cirrhotic patients with more severe liver disease, and might be a useful prognostic marker
ABSTRACT
Cardiovascular disease is a leading cause of morbidity and mortality in the industrialised world. Observational studies have demonstrated a clear link between elevated serum low density lipoprotein [LDL] cholestrol concentrations and coronary heart disease, making hyperlipidaemia a significant modifiable risk factor that can be targted. Statins reduce cellular cholesterol synthesis and rapidly became popular for the primary and secondary prevention of coronary artery disease because they cause larger and clinically significant reductions in cholesterol levels, with few serious adverse effects, and are well tolerated by patients. Most manufacturers of statins recommend that they are taken at night, on the basis of physiological studies which show that most cholesterol is synthesized when dietary intake is at its lowest. Moreover, many patients also receive treatment with other cardioprotective drugs at night and compliance may be compromised by multiple dosing. The aim of this study was to determine wheather adminstration of atorvastatin in the morning had significant different efficacy from its adminstration in the evening. This study was done on forty patients of both sex of age range 44-72 years. Patients were randomised on either 10 or 20 mg/day of atorvasatin in the morning or in the evening for six weeks each. Neither sex nor daily doses variation [10 or 20 mg/day] produced significant changes in lipid profiles between baseline and follow up data in all groups. Switching dosing atorvastatin from in the morning to in the evening the resulted in statistically significant decrease in total cholesterol, LDL cholesterol and triglyceride and non-significant increase in HDL cholesterol value
ABSTRACT
Refractory ascites is frequently a manifestation of end stage liver disease, and is most often associated with a poor prognosis. The efficacy and complications of peritoneovenous shunt have given conflicting results. The use of Denver shunt as a line of therapy is expected to add a more preload to the heart in such patients. The aim of the present echocardiographic study is to evaluate such expected changes in cardiac function in those patients. Ten patients with tense, refractory ascites [age ranged 36-52 years] were carefully selected for Denver peritoneovenous shunt and followed up clinically, and echocardiographically in the period from January 1998 to January 2000. The left ventricular outflow tract diameter was found to be sign increased after shunt operation [P<0.05], reflecting a deleterious effect on left ventricular function. In addition the right ventricular diastolic diameter as well as the tricuspid valve excursion were sign increased [p < 0.05, < 0.01 respectively]. Moreover the right ventricular function showed a sign reduction in right ventricular pre-ejection period / right ventricular ejection time RVPEP / RVET [p<0.05], reflecting both increased tricuspid valve flow as well as pulmonary hypertension with de creased right ventricular systolic function. It could be concluded that the major hemodynamic changes in cirrhotic patients with refractory ascites early after Denver shunt consist of exaggeration of hyperkinetic state and a minor rise of pulmonary artery pressure. Therefore it may be recommended that a preoperative echocardiographic evaluation of both cardiac function and pulmonary artery pressure determination is mandatory in cirrhoticpatients with refractory ascites