Circadian pattern of acute variceal bleeding in Egyptian patients

Chronic liver disease leading to cirrhosis is the most common cause of portal hypertension which may end in serious bleeding from gastro-oesophageal varices. Recent studies have demonstrated a daily pattern of acute upper gastrointestinal bleeding in patients with liver cirrhosis evidenced by one or two peaks throughout the day. The assessment of the circadian rhythm of acute variceal bleeding with the possible participation of circadian changes of the fibrinolytic parameters. The study included 264 patients with liver cirrhosis and upper gastrointestinal bleeding in addition to 20 healthy subjects as a control group. The assessment of fibrinolytic parameters was completed in 60 of the patient group in addition to the control group. The fibrinolytic activity was assessed by estimation of Tissue plasminogen activator antigen [tPA: Ag] and Plasminogen activator inhibitor antigen [PAI-1: Ag], the latter is considered the fast acting inhibitor of plasminogen activators. We observed statistically significant 2 time peaks of upper gastrointestinal bleeding at hour 04:00 and hour 17:00 with overlapping peak of the fibrinolytic parameter, tissue plasminogen activator antigen, with the night peak of bleeding. There are 2 time peaks of upper gastrointestinal bleeding with a temporal association between the night peak and a relative hyperfibrinolytic state

noninvasive index for diagnosing fibrosis and/or cirrhosis in patients with chronic hepatitis C

Chronic hepatitis C is one of the most prevalent infectious hepatic diseases in our locality. Histological examination of the liver is an integral part of the evaluation of patients with chronic hepatitis C. There are many non invasive approachs to assess the degree of liver fibrosis and/or cirrhosis in chronic hepatitis C patients. to construct one simple model consisting of routine laboratory data to predict both significant fibrosis and cirrhosis among patients with chronic hepatitis C. A total of 32 patients with positive hepatitis C virus [HCV] antibodies. All were subjected to thorough clinical evaluation, liver function tests, abdominal ultrasonography and liver biopsy with grading of hepatic fibrosis and steatosis. Platelet count and Aspartate amino transferase [AST] were the most important predictors of significant fibrosis and cirrhosis. The severity of liver fibrosis has correlated significantly with the gradual increase of AST level [P<0.001] as well as the decrease of platelet count [P=0.001]. AST to platelet ratio index [APRI] has correlated significantly with the stage of fibrosis. This index had a higher correlation coefficient than platelet count or AST level alone