Correlation of Transcutaneous Bilirubin with Serum Bilirubin in Term and Preterm Neonates with Jaundice

Background: Jaundice is a very common neonatal problemand contributes a lot to the admission into neonatal care unitsand hospitals. Early estimation of TcB may help identifyingneonates with significant jaundice requiring serum bilirubinestimation. This may help avoiding unnecessary estimation ofserum bilirubin by invasive method in preterm and termneonates. TcB has been practised mostly in the whitepopulation and studies in the nonwhite population is relativelyscarce. In Bangladesh, estimation of TcB is a very newapproach and not in practice in most of the centres; andinvolves only term and near-term neonates sparing pretermones.Objective: To evaluate the correlation of transcutaneousbilirubin with serum bilirubin in term and preterm neonates withjaundice.Methods: This cross sectional study was conducted in thedepartment of Neonatology, Bangabandhu Sheikh MujibMedical University (BSMMU) from September 2015 to August2016. Jaundiced neonates ranging from 28 to 42 weeks ofgestation were studied. JM-103 device and DichlorophenylDiazonium method were used to measure TcB and TSBrespectively. TcB measurements were obtained over thesternum 30 minutes prior or after blood sampling for TSB.Pearson’s correlation coefficient and linear regression analysiswere used to determine the correlation between TcB and TSB.Bland-Altman plot was used to analyse the agreement betweenTcB and TSB. ROC curve was constructed both for term andpreterm infants to determine the best cut-off values with theirsensitivity and specificity.Results: A total of 148 paired TcB-TSB readings for 102jaundiced term and preterm infants were obtained. Correlationcoefficient in total population, term and preterm neonates were0.83, 0.92 and 0.69 respectively. Bland-Altman plot showedreasonable agreement in term newborns but not in pretermbabies. Overall best sensitivity and specificity of TcB in termneonates was 90% and 73%, and in preterm neonates 65%and 60% respectively. Area under the curve for TcB was 86%in term neonates, whereas it was 63% in preterm neonates.

Health risk behaviours of Palestinian youth: findings from a representative survey

Background: There is little systematic information about health risk behaviours among youth in Middle Eastern countries, leaving public health authorities unprepared to deal with emerging public health threats at a time of major social change. Aim: The Palestinian Youth Health Risk study investigates patterns of risk behaviours among Palestinian youth, their perceptions of the risks and benefits of such behaviours, and the relationship of exposure to violence with mental health and engagement in risk behaviours. Methods: We conducted a representative survey among 2500 individuals aged 15–24 years in the West Bank and East Jerusalem, permitting reliable comparison across sex and rural–urban divisions. A stratified 2-stage random sample was drawn from the 2007 population census, with strata formed by crossing the 12 governorates with urban, rural and refugee camp locations. Within strata, 208 survey clusters were sampled with probability proportional to size. Within each cluster, 14 households with youth of the appropriate age were sampled. Results: Among youth aged 20–24 years, 22.4% of males and 11.6% of females reported trying alcohol; 10.5% of males and 4.3% of females reported trying drugs. Almost one quarter of unmarried youth aged 20–24 years reported any sexual experience. Tobacco use is high, even among younger youth [45.4% of males and 21.2% of females aged 15–19 smoke]. Risk behaviours are higher among males, older youth and in urban areas and refugee camps. Conclusion: While smoking is of particular concern, prevention outreach for all behaviours should be directed at subgroups and areas identified as highest risk

Comparative study between fibro-test and egy-score as non-invasive markers for assessment of hepatic fibrosis in chronic hepatitis c

Backgound: Liver fibrosis [LF] occurs in response to almost all causes of chronic liver injury. Assessing LF is important for both predicting disease progression and monitoring efficacy of therapeutic measures. Most noninvasive tests of liver fibrosis were developed with the aim of discriminating between ginsignificanth, [F0-F1] by METAVIR and clinically gsignificanth fibrosis [. F2] by METAVIR or for identifying or excluding established cirrhosis in patients with well compensated chronic liver disease. Both these aims are clinically the most relevant

Aim: We aimed to compare the diagnostic accuracy of FibroTest and Egy-Score as predictors of stage of hepatic fibrosis in a prospectively enrolled cohort of Egyptian patients with chronic hepatitis C

Patients and Methodlogy: Twenty patients, treatment naive chronic hepatitis C patients were enrolled. They were 16 males [80%] and 4 females [20%] mean age of these patients was 53.55 +14.3 [rang 18_73 years]. The study was carried out in the Department of Gastroenterology and Hepatology, Elhussin hospital, Al-Azhar University during the period between March 2016 and March 2018

Results: Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and fibrotest. Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and EGY-SCOR. Our scores depend mainly on simple routinely used laboratory parameters [total bilirubin, albumin, platelet count] in addition to age and 2 non routine tests [CA 19-9 and Alpha-2-Macroglobulin]. Although this panel needs to be done in validated laboratories, the cost of our score is much cheaper than other well-known and patented tests such as FibroTest and the net results of both methods nearly the same

Conclusion: Egy-Score can be applied easily in clinical practice to exclude severe hepatic fibrosis/cirrhosis in patients with contraindication for liver biopsy or those who are reluctant to do it. Egy-score would need further valida-tion to be regarded as an alternative to liver biopsy

Recommendations: Physician should be careful when interpreting elevated levels of tu-mor markers CA 19-9 and CA 125 in patients with chronic liver disease as this could be a benign elevation related to hepatic fibrosis and not necessarily due to underlying malignancies. Elevation of the tumor markers such as CA19.9 have been associated with cholestasis in liver disease patients and this may give false positive results for our scores which give Limitations to our study

Muscle cramps in patients with liver cirrhosis

Muscle cramps are involuntary, painful, visible, or palpable muscle contractions of abrupt onset, generally occurring at rest and are often nocturnal. The pain and contraction resolve spontaneously in seconds to several minutes. The calf is the area most commonly affected, but may affect fingers and hands. The reported prevalence of true muscle cramps in cirrhotic patients varies from 22 - 88%. Clinically; significant muscle cramps occur less frequently [8 - 20%]. Thirty patients were chosen for this study to estimate the prevalence of muscle cramps among patients with liver cirrhosis irrespective of the etiology, to find the role of zinc in the pathogenesis of cramps in patients with liver cirrhosis and to find the relation between the clinical; laboratory; ultra-sonography of the liver and muscle cramps. They were divided into two groups: Group [A] twenty patients with liver cirrhosis were further subdivided according to the presence or absence of muscle cramps into: Sub-Group [A1]: included 14 patients with liver cirrhosis and muscle cramps [7 males and 7 females] with a mean age of 56.5+/-5.25 years. Sub-Group [A2]: included 6 patients with liver cirrhosis without muscle cramps [5 males and 1 female] with a mean age of 57.5+/-4.37 years. Group [B] included 10 patients with congestive heart failure [6 males and 4 females] with a mean age of 55.6+/-11.32 years. Results revealed that muscle cramps was more prevalent in patients with liver cirrhosis, compared to patients with congestive heart failure [70% vs 20% with P< 0.01]. There was a significant relation between the frequency of occurrence of cramps and the presence of haematemisis, Jaundice, ascites, splenic size, portal vein diameter, low serum albumin, high serum bilirubin and low serum sodium, calcium, as well as there was a significant relation between a low serum zinc level and the occurrence of cramps in liver cirrhosis. There was no relation between liver enzyme and serum alkaline phosphatase and cramps in liver cirrhosis. On conclusion muscle cramps are a common symptom in patients with cirrhosis and can be triggered by many factors especially a low serum zinc level