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

Association of hyperleptinemia and insulin resistance with ischemic heart disease in type II diabetes

Insulin resistance and hyperinsulinemia often coexist with a cluster of metabolic factors including visceral obesity and referred to as the metabolic syndrome. These factors contribute to increased risk to type II diabetes and to ischemic heart disease. We investigated whether plasma leptin and insulin levels were linked with the coronary heart disease independent of the presence of diabetes mellitus. This study was conducted on 80 persons who were divided into 4 groups. Group I included 20 healthy volunteers Group II included 20 patients suffering from IHD without DM. Group III included 20 patients suffering from DM without IHD and Group IV included 20 patients suffering from both DM and IHD. Investigations were done including; FBS, PPS, urea, creatinine, cholesterol, TG, LDL-c, HDL-c, fasting serum insulin and leptin using RIA technique in addition to an EGG. Insulin resistance was calculated using HOMA test. Both mean leptin level and insulin resistance showed no statistical significant difference between ischemic heart disease group and the control group, but were significantly higher in diabetic groups [III, IV] than non-diabetic groups [I, II]. Within diabetic patients we found no significant difference in leptin and insulin resistance levels between those with IHD and those without IHD. In our study we found positive correlation between insulin resistance and BMI, cholesterol, LDL-c and leptin within ischemic heart disease group. Leptin and insulin resistance are associated with increased risk for atherosclerosis and ischemic heart disease in the presence of diabetes mellitus