ABSTRACT
Background and study aims: Many regimens are tried in managing overt hepatic encephalopathy [HE]. We investigated the efficacy of rifaximin versus metronidazole in management of an acute episode of HE on top of cirrhosis
Patients and methods: An open label prospective controlled trial was conducted on patients with an acute episode of HE on top of cirrhosis who were randomly divided into metronidazole-group [M-group] and rifaximin-group [R-group] with 60 patients in each The main outcome measure was the clinical improvement of HE, duration of hospital stay and the changes in the level of serum ammonia after 3?days of starting therapy
Results: Both M-group and R-group were comparable as regards age and sex [mean age 51 +/- 11 years and 49 +/- 12; male/female ratio 45:15 and 50:10, respectively]. Forty-six patients [76.7%] in M-group compared with forty-five [75%] in R-group showed clinical improvement [p = 0.412]. Hospital stays were comparable between both group; 4.2 +/- 2.1 and 3.9 +/- 1.7 for M-group and R-group; respectively [p = 0.435]. There was no significant difference of venous ammonia levels [Mean of delta 160.77 +/- 185.34 µg/dL and 207.95 +/- 218.43 µg/dL with p 0.664 and 0.974 in M-group and R-group, respectively]. No adverse events were reported throughout the whole study
Conclusion: Rifaximin and metronidazole are equally effective in management of acute episode of overt HE, therefore, re-auditing of treatment protocols of HE are warranted especially in limited resource settings
ABSTRACT
Folate and vitamin B[12] are important in ensuring proper DNA replication and normal cell division. Their depletion might enhance carcinogenesis. The sulphur containing amino acid homocysteine gained considerable interest as a useful marker of impaired function of folate and vitamin B[12]. The present work aimed to evaluate plasma homocysteine level as a more sensitive indicator of folate and vitamin B[12] status in children with acute lymphoblastic leukemia. This study included fifteen children with newly diagnosed acute lymphoblastic leukemia attending pediatric department of Shatby Hospital, Alexandria University. The control group included fifteen normal healthy volunteers matched for age and sex. In patients, blood samples were collected at the time of diagnosis before any treatment. RBC's folate, plasma folate and vitamin B[12] were estimated using RIA kit. Plasma homocysteine was determined using EIA kit. RBC's folate, plasma folate and vitamin B[12] were significantly lower while plasma homocysteine was significantly elevated in the patient group when compared to the control group. Plasma homocysteine correlated negatively with RBC's folate in both studied groups. This study showed a strong association between folate deficiency, hyperhomocysteinemia and ALL in children. Prospective studies are necessary to further define whether alterations in plasma tHcy and RBC's folate levels can be considered as risk markers or are a consequence of progression of acute lymphoblastic leukemia