Chronic hepatitis C; "APRI score a noninvasive marker, its predictive value for determination of hepatic fibrosis and liver cirrhosis at tertiary care hospital Hyderabad/ Jamshoro"

ABSTRACT: The major causative factor of hepatic cirrhosis and its complications in chronic hepatitis C is due to presence of liver fibrosis. To assess prognosis and management related decisions, the exact staging of liver fibrosis is of greatest importance. Now, liver biopsy is the inexact gold standard for this purpose. APRI or AST to platelet ratio Index is the best noninvasive marker which can predict presence of fibrosis in majority of chronic hepatitis C patients without the need of biopsy. It is also cost effective and only depends on routine testing [Platelet count and serum AST]

Objectives: To determine the positive predictive value of APRI Score for the prediction of fibrosis and cirrhosis in chronic hepatitis C patients. Study design: Cross sectional study. Setting: Medical wards and Out Patient Medicine Department of Liaquat University Hospital Hyderabad / Jamshoro. Period: 6 months

Methodology: A total of 51 patients of either gender, age >14 years presenting to Medical wards and OPD for the evaluation of chronic hepatitis were enrolled in this research study after giving preference and avoiding criteria. Clinical data was collected at the time of liver biopsy and blood samples for liver function tests, blood glucose and complete blood picture with platelet count were collected before the biopsy [only AST and platelet count are needed for APRI score] a core biopsy needle of 14 gauge was used and the procedure was conducted under ultrasound guidance. Fibrosis stage was determined according to the METAVIR group scoring system. The patients were examined in a very comfortable manner and all the information collected from the patients was kept confidential and entered in the predesigned proforma

Results: A total of 51 patients were selected for this study. Out of these 31 [60.78%] were male and 20[39.22%] were female. The mean age was 42.53 years [ +/- 11.2 SD]. The positive predictive value for APRI score between 0.5 to 1.0 was 58.82% whereas the positive predictive values for APRI score 1.1-1.5 was 70.58%

Conclusion: The positive predictive values of APRI score in the ranges of 0.5 to 1.5 were not indicative of the presence of significant liver fibrosis in this research study. However, additional data are required to authenticate or disprove the usefulness of APRI score for the prediction of significant hepatic fibrosis in chronic hepatitis C patients

Essential hypertension; [evaluation of serum uric acid at tertiary care hospital hyderabad/jaivishoro]

Little and sparse information is present in our population on association between serum uric acid and essential hypertension .Increased serum uric acid is related with elevated blood pressure in different research studies. The relationship between serum uric acid level and high blood pressure can be difficult to assess because drugs for high blood pressure usually affect uric acid level. The objective of our study is to evaluate the association of serum uric acid to severity and duration of essential hypertension at Liaquat University Hospital [tertiary care] Hyderabad / Jamshoro. Case control and prospective study. Medical wards and Out Patient Medicine Department of Liaquat University Hospital Hyderabad /Jamshoro. One year i.e. from 20[th] March 2013 to 19[th] February 2014. A total of 75 high blood pressure subjects aged 35 years and above were included as cases with same number[75] of age and sex matched normal blood pressure subjects as controls after excluding, Secondary hypertension, metabolic syndrome ,Diabetes Mellitus, age <40 ;>70 years, hypothyroidism, hyperparathyroidism, Ischemic heart disease, congestive cardiac failure, Alcohol abuse, Renal Insufficiency, glomerulonephritis, pyelonephritis, hereditary nephropathy, patients on drugs -, ethambutol levodopa pyrazinamide, low dose asprin, Cytotoxic drugs, nicotinic acid ,thiazide diuretics.. Qualitative and quantitative data were evaluated in SPSS version 16.0. The mean serum uric acid level was 6.3 +/- 1.4 mg/dl vs 4.5 +/- 1.2 mg/dl in case [n = 75] and control patients [n = 75] respectively. A total of 23 [30.6%, n = 75] patients in cases and 8 [10.6%] subjects in control had high serum uric acid [Odds Ratio 2.13, p <0.05]. Therefore, the frequency of increased serum uric acid level subjects and mean serum uric acid level were significantly greater in hypertensive cases, as compared to those of healthy normal blood pressure Controls. Serum uric acid correlated positively with both systolic blood pressure [r=0.132, p<0.01] and diastolic blood pressure [r=0.214; p<0.01]. High serum uric acid is frequent in our populace with essential hypertension and there is relationship between serum uric acid level and blood pressure. Further large scale research studies on the pathophysiologic significance of high serum uric acid in these high blood pressure patients are in further need

Chronic kidney disease; study on patterns of anemia in relation to glomerular filtration rate [GFR] in patients

Chronic kidney disease is usually related with anemia and the level of anemia correlates with the severity of renal failure. A chronic kidney disease is complicated by anemia and anemia may contribute to adverse clinical outcomes. No large-scale population data are available for patients with chronic kidney disease regarding prevalence of anemia, subpopulations at risk, and relationships between anemia and renal dysfunction

Objectives: The objective of this study is to determine the frequency of different patterns of anemia in relation to glomerular filtration rate in patients suffering from chronic kidney disease stage II and above Patients

Material and Methods: Study Design: Cross sectional study

Setting: Medical and Nephrology wards of Liaquat University Hospital Hyderabad / Jamshoro

Period: 20[th] January 2013 to 19[th] December 2013

Results: During the study period, total 339 patients of chronic kidney disease with stage II and above patients were enrolled. The mean age +/- Standard Deviation and range] of patients was 50.65 +/- 11.86 [16 to 80 years, n = 339]. 211[62.2%] were male and 128[37.8%] were female. [Male to Female Ratio 1: 6]. Mean Hemoglobin +/- SD was 7.16 +/- 3.89 [3.0 to 17.0 g/dL]. The frequency of anemia was present in 285[84.1%] patients with mean Hb +/- SD 6.02 +/- 2.1 [g/dL]. The mean weight +/- SD was 56.50 +/- 9.84 [40 to 81 kg]. The mean serum creatinine +/- SD was 5.63 +/- 2.48 [0.9 to 12.0 mg/dL] and we observed that most frequent pattern of anemia was normocytic-normochromic anemia in 216[77.0%] patients, hypochromic-microcytic in 61[18.0%] and macroyctic in 17[5.0%] patients. We also found that as anemia increased progressively with declining GFR with mean hemoglobin concentration of 11.78 +/- 2.8 g/dL in CKD stage 2, 10.14 +/- 3.6 g/dL in CKD stage 3, 6.8 +/- 3.6 g/dL in CKD stage 4, 7.44 +/- 4.0 g/dL in CKD stage 5

Conclusion: Frequency of anemia increases with the progression of stage of chronic kidney disease [decreased GFR] and anemia was most common in stage 5 patients of chronic kidney disease. Most frequent pattern of anemia is normocytic normochromic anemia