Insulin and glutamic acid decarboxylase antibodies in chronic hepatitis [C] patients with diabetes mellitus

Diabetes mellitus is associated more with HCV chronic liver disease than in the general population and in the other types of chronic liver disease. The increased incidence of diabetes in HCV patients might be related to an autoimmune process produced by the virus or the virus itself has a cytopathic effect on the pancreatic beta clells. The aim of this work was to study the plasma basal insulin level and the seropositivity against glutamic acid decarboxylase [GADA] - an islet cell cytoplasmic antigen. Patients: the study was carried out on 45 patients categorized into 3 equal groups. Group I included 15 diabetic patient with HCV chronic liver disease, Group II included 15 diabetic patients with chronic liver disease which is not related to HCV, Group III included 15 non diabetic patients with HCV chronic liver disease. All patients were selected to be matched regarding age, sex and sevirity of liver disease. The results showed that basal insulin level [22.4 +/- 23.1 micro IU/ml in group I, 21.6 +/- 23.8 micro IU/ml in group II, and 8.8 +/- 6.4 micro IU/ml in group III] were significantly higher in the diabetic patients [GI and GII] compared to the non diabetic [GIII] [P<0.01]. The insulin resistance index as calculated by HOMA equation [9.6 +/- 7.9 in group I, 9.2 +/- 10.3 in group II and 2.4 +/- 1.2 in group III], were also significantly higher in the diabetic groups [p < 0.01]. Seropositivity for [GADA] was 9/15 [60%] of patients of groups I and III and 3/15 [20%] of patients of group II. We concluded that diabetes mellitus associated with HCV chronic liver disease in characterized hyperinsulinaemia and increased insulin resistance. There may be a role of autoimmunity in the pathogenesis of diabetes in HCV chronic liver disease. Follow up of the non diabetic HCV patients with positive GADA for development of diabetes is recommended

prognostic value of congestion index in patients with portal hypertension due to schistosomal hepatic fibrosis with and without chronic hepatitis C: a clinico-pathological and hemodynamic study

We intended to assess the value of congestion index of portal vein [Cl PV] [derived from the ratio between the cross-sectional area of the portal vein and the mean velocity of portal flow] in assessing the severity of portal hypertension and its correlation with North Italian Endoscopic Club [NIEC] index and risk of bleeding in patients with schistosomal hepatic fibrosis with and without chronic hepatitis C. We studied 64 patients with portal hypertension who were categorized into three groups based on histological diagnosis: group I [19 with pure schistosomal hepatic fibrosis], group II [22 patients with combined schistosomal hepatic fibrosis and chronic hepatitis C] and group III [23 patients with combined schistosomal hepatic fibrosis and chronic hepatitis C with cirrhosis]. All patients were of the Child class A.They were subjected to; clinical examination, stool and serological examinations for schistosoma infection, serum transaminases and alkaline phosphatase, serum albumin, prothrombin activity and virological markers. Upper endoscopy, abdominal Ultrasonography with duplex as well as liver biopsies were performed to all patients. The results showed that the mean value of Cl PV was found to be higher in groups II [0.155 +/- 0.05] and III [0.179 +/- 0.04] than in group I [0.134 +/- 0.04], which reached a significant level only between groups III and I [P<0.05]. The mean values of NIEC index and NIEC risk of bleeding were found to be significantly higher in group III [28.5 +/- 4, 18.3 +/- 6.3] respectively than in groups I [23.6 +/- 5, 10.6 +/- 7.8] and II [23.5+4, 11+6.5] [P<0.05] with no significant difference between groups I and II. The Cl PV was found to have a significant positive correlation with the degree of fibrosis as assessed by both the sonographic and the histopathologic examinations. It was also significantly correlated with NIEC risk of bleeding. We concluded that the congestion index of portal vein is a valuable non invasive parameter in assessing the severity of portal hypertension and in predicting bleeding in schistosomal patients with and without chronic hepatitis C

role of ultrasonography to discriminate between schistosomiasis and virus-related chronic liver disease

The aim of our study was to assess the role of ultrasonography in patients with chronic liver diseases in discriminating between schistosomiasis and viral hepatitis infections in Egypt, an area where these infections are endemic. We assessed 114 patients with chronic liver disease, clinically, ultrasonographically, biochemically, virologically, parasitologically and by liver biopsy. According to histological diagnosis; 7.9% of patients had portal fibrosis, 43% chronic hepatitis, 47.4% cirrhosis and 1.8% hepatic malignancies. Patients with cirrhosis 44 [49.4%] of them had pure HCV infection. The longitudinal diameter of the spleen was significantly higher in patients with cirrhosis- virus related liver disease than those with pure schistosomiasis, while no significant differences were found in the degree of periportal thickening between the two groups. This study shows that ultrasonography alone can not be used as a screening procedure to discriminate between schistosomiasis and viral hepatitis infections in areas where these infections are highly associated, such as in Egypt