Secondary gastric varices in hepatic cirrhosis

To determine the frequency of secondary gastric varices after esophageal variceal eradication in patients with cirrhosis of liver and factors associated with their development. Observational study. The Department of Gastroenterology, Liaquat University Hospital, Jamshoro and Isra University Hospital Hyderabad, from September 2007 to July 2009. Consecutive patients with decompensated cirrhosis of liver were subjected to endoscopy for management of varices. Endoscopic variceal band ligation was done in all patients. Secondary gastric varices were noted at surveillance. Receiver-operating characteristic [ROC] curves were used to determine the cut off values of secondary gastric varices and various factors influencing the development of gastric varices after eradication with the best sensitivity and specificity. Of the 162 patients; 46 [28.3%] were females and 116 [71.7%] males. The mean age was 45 +/- 13 years. Fundal varices were present before eradication in 12 [7.4%] patients and after eradication of varices in 38 [23.5%] patients. A strong association was found between gastric varices after eradication and Child Pugh class [p=0.001], grade of varices at the time of presentation [p=0.024], increasing number of sessions for eradication of esophageal varices [p=0.001] and presence of gastric varix at the time of first presentation [p=0.009]. Secondary gastric varices are common in cirrhosis. A significant association with Child-Pugh class, presenting grade, increasing number of ligation session and prior existence was seen in the studied group

MELD Era: is this time to replace the original child-pugh score in patients with decompensated cirrhosis of liver

To compare the predictive value of MELD [Model of end stage liver disease] and Child-Pugh [CP] scores in patients with decompensated cirrhosis of liver. Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007. This study included 110 consecutive patients with decompensated cirrhosis of liver diagnosed either clinically or radiologically were followed-up during hospital stay. Studied variables included demographic data, cirrhosis related complications and investigations. Patients were classified according to original CP classification into A, B and C. MELD score was estimated from serum bilirubin, serum creatinine and INR [International normalized ratio] of the patients. Duration of hospitalization and in-hospital mortality were made as the end points of the study. T-test and Chi-square test were done for continuous and categorical data. Original CP and MELD score were compared by the ROC curve. 0.05 was kept as the level of significance. There were 110 patients with decompensated cirrhosis of liver. Mean age was 46.76 +/- 12.93 years. There were 72 [65%] male and 38 [35%] females patients. Hepatitis C was the most prevalent cause of cirrhosis of liver present in 60/110 [60%] cases. Ascites was present in 93/110 [83%] patients. The mean MELD scores were 2.23 +/- 0.712 [95% CI 2.09-2.36] and for CTP 2.52 +/- 0.586 [95%; CI 2.41-2.63]. The outcome of the patients were 12 deaths [11%]; 54 [49%] remained hospitalized for up to 14 days and 44 [40%] for>14 days. The majority of deaths and prolong hospitalization were found in patients with MELD score>15 as well as with Child-Pugh grade C. The c-statistic was 0.726 [p=0.001] for CP score, and 0.642 for MELD score [p=0.021]. The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study

Validation of three non-invasive markers in assessing the severity of liver fibrosis in chronic Hepatitis C

To compare various biochemical markers i.e. APRI [AST to platelet ratio index], aspartate aminotransferase [AST] alanine aminotransferase [ALT] ratio, FIB-4 [AST, platelet, AST and age] with biopsy for assessing the severity of hepatic fibrosis in patients with hepatitis C. Study Design: Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2005 to March 2007. Consecutive hepatitis C virus RNA positive and previously untreated patients were studied. Liver biopsy with histological evaluation and AST/ALT ratio, AST to platelet ratio index and FIB-4 were assessed in all patients. Receiver operative curves were developed. There were 158 patients [109 males, 49 females]. On histological grounds non-advanced fibrosis [F0-1] was present in 74 [46.5%] of cases, whereas 84 [53.5%] patients had advanced [F2-4] fibrosis. The area under the receiver operating characteristic curves of APRI < 0.05-1 and FIB-4 < 1.45 were 0.7 and 0.74 respectively, which means that APRI < 1 and FIB-4 < 1.45 will exclude advanced fibrosis in 70% and 74% of patients respectively. An APRI of > 1 and FIB-4 will predict advanced fibrosis in 87% and 98% of patients respectively. AST/ALT ratio was inferior to both of these biomarkers. Both APRI and FIB-4 not only exclude minimal fibrosis but can predict advanced fibrosis in the majority of the patients. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy

Serum electrolytes changes in malnourished children with diarrhea

To determine the frequency of electrolyte disturbances in malnourished children with and without diarrhea and whether these findings have therapeutic value or not. It is a descriptive study conducted at pediatric Unit-II LUH Hyderabad, from1st August to 31st September 2004. One hundred children of protein-calorie-malnutrition between 6 months to 5 year of age of either sex who were admitted due to diarrhoea, failure to thrive, acute respiratory infection, malaria, anemia, cardiac failure and feeding problems were included in the study. On the basis of history, physical examination and anthropometrics measurement they were divided into Group A patients [n=64] who were malnourished but had diarrhoea and Group B patients [n=36] who were also malnourished and had no diarrhoea. Serum electrolytes were done in patients of both groups and the results were analyzed statistically. Analysis of serum electrolyte in both groups revealed that hypokalemia, hyponatremia and low serum bicarbonate were seen more frequently in patients of group A as compared to group B. In group A hypokalemia was seen in 40 patients[62.5%] while it was observed in 8 patients[22.22%] in group B [p<0.001], hyponatremia was seen in 17 patients [26.56%] in group A and in 5 patients [13.88%] in group B [p<0.001]. In group A 41 patients [64%] had low serum bicarbonate while in group B only 15 patients [41.66%] had low serum bicarbonate value [p<0.001] Electrolyte changes were commonly seen in grade II and III malnourished patients particularly who presented with diarrhoeal episode of variable duration. If these changes are diagnosed in time and treated appropriately the morbidity and mortality could be decreased