Quality of life assessment in Pakistani patients with chronic liver disease

To find out if advanced liver disease causes decrement in health related quality of life in Pakistani patients. An observational study was conducted at the Shifa International Hospital Islamabad. Chronic Liver Disease Questionnaire [CLDQ] was administered to patients with liver disease who were either admitted or seen as outpatients. Patients were divided into two groups. Those with no cirrhosis or Child's Class A were placed into group A. Those with advanced liver disease i.e. Child's Class B and C into group B. A total of 56 patients [mean age 50.6 years] were included in this study. Hepatitis C was the cause of chronic liver disease [CLD] in 52 [92.9%] patients. Twenty-one [37.5%] patients were in group A and 35 [62.5%] in group B. Patients with advanced liver disease had significantly lower CLDQ scores as well as decrement in five out of the six categories for assessing quality of life. Chronic liver disease causes significant impairment in the Quality of Life Index [QLI] in Pakistani patients

Steatosis and chronic hepatitis C virus infection

To asses the presence of steatosis and other histological changes in patients with chronic hepatitis C. Liver biopsy samples were reviewed for presence of steatosis, its degree and other histological changes of hepatitis C including necro-inflammatory score, fibrosis grade and these changes were correlated with liver function tests. A total of 109 liver biopsy samples were reviewed. Mean age of the patients was 44.46 +/- 13.93 years and 62 [56.8%] were male. Mean necro-inflammatory score was 2.32 +/- 0.95. Mean fibrosis grade was 1.69 +/- 1.12. No Steatosis was found in 42 [38.5%] samples and mild to severe degree of steatosis was found in 67 [61.5%] samples. In this study, nearly 62% of liver biopsy samples had some degree of steatosis. Whether this steatosis increases occurrence of severe form of fibrosis or is an associated phenomena with chronic inflammation needs to be further clarified

Tropical sprue: revisited

To review the experience of patients presenting with clinical manifestations of tropical sprue and assess their diagnosis and management, response to treatment and follow up. This single center retrospective descriptive study was done at Shifa International Hospital, Islamabad from January 1994 to January 2003. All patients who presented with diarrhea, anorexia, weight loss and anemia and who proved to have partial villous atrophy on intestinal biopsy and had responded to treatment with antibiotic and folic acid,were included in this review. A total of 42 patients were encountered during these years. There were 31 [74.0%] males and 11 [26%] females. The age ranged from 17-66 years. All patients presented with diarrhea, weight loss, anorexia and had megaloblastic anemia. In all patients, a distal duodenal biopsy showed partial villous atrophy. All were treated with tetracycline 1 g per day and folic acid 5 mg per day and responded to treatment within 4 weeks. Total treatment lasted 3 months and resulted in complete resolution of symptoms and gain of weight. The follow up lasted for a mean of 5 years and no relapses were noted. Tropical sprue presents with diarrhea, anorexia, weight loss, and megaloblastic anemia. The partial villous atrophy has been a constant finding. The response to treatment to tetracycline and folic acid has been uniformly successful

Serum aminotransferase levels and platelet count as predictive factor of fibrosis and cirrhosis in patients with chronic hepatitis C infection

To assess the ratio of aminotransferases in combination with platelets count as a predictive factor for stages of fibrosis in patients with chronic hepatitis C virus infection. A total of 266 patients were evaluated retrospectively who had undergone liver biopsy as a part of their evaluation for the management of chronic hepatitis C infection at Shifa International Hospital from 1998 to 2002. All these patients had complete blood counts and liver function tests including transaminases. The ratio of AST/ALT and platelet count of <150,000 were noted and degree of the fibrosis and cirrhosis on liver biopsies were matched. None of these patients had history of alcohol consumption. The fibrosis stages used were according to METAVIR score. An AST/ALT ratio of >1 and a platelet count of <150,000 had sensitivity of 85.6 and specificity of 90.0 with positive predictive value of 91.2 and negative predictive value of 83.4 for the fibrosis grade-III and IV. An AST/ALT ratio of <1 and a platelet count of >150,000 for grades 0-2, the sensitivity was 87.3, specificity 60.0, PPV 87.3 and NPV 48.0. An AST/ALT ratio of >1 in combination with a platelet count of <150,000 can predict advance stage of fibrosis and cirrhosis in patients with chronic hepatitis C infection. In these patients, a liver biopsy may not be necessary