Revising the criteria for the predictors of variceal haemorrhage outcome

Background and study aims: There are many criteria and definitions used to evaluate the failure to control and prevent variceal bleeding. Baveno criteria were developed in Baveno consensus workshops I-III. Some of these criteria are fairly difficult to apply and do not adequately reflect common situations that are observed in clinical practice. Therefore, new criteria were developed at the Baveno-IV workshop. In the present study, we aimed to evaluate the validity of Baveno II-IV criteria in the prediction of bleeding recurrence among patients with liver cirrhosis who presented with bleeding oesophageal varices

Patients and methods: Fifty patients with liver cirrhosis and acute variceal bleeding were divided into two groups according to treatment response. Group I consisted of 44 patients for whom treatment to control bleeding was successful, and Group II included 6 patients for whom treatment failed. Baveno criteria were used in the evaluation of treatment outcome in these patients

Results: The overall accuracy of Baveno II and III criteria was 87.3% within the first 6 h and 76.5% after 6 h, with a mean accuracy 81.9%. The overall accuracy of Baveno IV criteria in this study was 83%. The criterion of death was also very specific [100%], with 100% PPV, but its sensitivity was very low [16.7%]

Conclusion: Baveno IV criteria are less complicated, much easier to apply and have nearly the same accuracy as Baveno II/III criteria. However, there are some criteria that need to be modified, such as the adjusted blood requirement index [ABR1], among others

Developing prevention model of acute lung injury: Validity of lung injury prediction score and risk panel

Background: Acute lung injury [ALI] is an example of a critical care syndrome with few therapeutic modalities once the syndrome is fully established, and little has been done on the prevention of ALI

Aim of the work: The aim of this work was to early identify the onset of acute lung injury [ALI] on admission and to prospectively evaluate the lung injury prediction score [LIPS]

Patients and methods: The study was carried out on 100 patients who aged >18 years, patients who had one or more of the acute lung injury [ALI] predisposing conditions on admission or within 6 h after were subjected to lung injury prediction score [LIPS]

Results: Acute lung injury developed in 15 patients, 11 patients [73.3%] had LIPS >3, while 4 patients [26.7%] had LIPS 3, with a statistically significant relationship between patients above and below LIPS value of 3 [P = 0.000], LIPS cutoff value of >/=3.5 on admission had a 73% sensitivity and 95% specificity with an area under the receiver operating curve of 0.883 [95% CI 0.782 to 0.984]. Sepsis and pneumonia were the most frequent risk factors [60%]

Conclusions: Lung injury predictive score [LIPS] could early predict patients at risk to develop ALI on admission, Hyperbilirubinemia, high blood urea level and abnormal chest X-ray on admission were not included in the original LIPS but had significant association with development of ALI

Role of multidetector computed tomography prostatic perfusion in diagnosis of prostate cancer

To evaluate the role of multidetector computed tomography prostatic perfusion in diagnosis of prostate cancer. From November 2007 to December 2009, 112 patients with suspected prostate cancer [with no previous histologic proof of prostate cancer] performed multidetector computed tomography prostatic perfusion followed by TRUS examination results were correlated with histopathological results from TRUS guided biopsy of the prostate were included in this thesis study. Our results are yielding multidetector computed tomography [functional ct "fct"] evaluation for detection of malignancy with sensitivity 90.54%, specificity 86.8%, positive predictive value 93.056%, negative predictive value 82.5%, accuracy 89.3% and pre-test probability = 64.3%. Multidetector computed tomography prostatic perfusion is a sensitive imaging modality the diagnosis of prostate cancer and should be routinely employed for raising the positive predictive value of prostatic biopsy