Transferrin and the prediction of spontaneous bacterial peritonitis

Patients with advanced liver disease are particularly susceptible to spontaneous bacterial peritonitis [SBP]. Pathogenic micro-organisms could survive and become more virulent in the presence of free iron. Thus, iron binding proteins provide protection against these organisms. The present study was conducted to evaluate the role of determining transferrin levels in serum and ascitic fluid, as well as its serum: ascitic fluid ratio [mg/mg] in differentiating between SBP and SA [sterile ascites] in cirrhotic patients. Moreover, the role of the ratio between ascitic fluid transferrin: ascitic fluid total protein [mg/g], as a marker for SBP was tested. Our study included 50 patients. Twenty five patients had SBP [according to Runyon's and Hoefs criteria] while the other 25 patients had SA. Our results revealed that patients with advanced liver impairment had higher susceptibility for SBP than SA. They had significantly higher serum total bilirubin [p<0.001] and significantly lower serum albumin and transferrmn [p<0.001, respectively]. More over, SBP group had significant prolongation of the prothrombin time [p<0.001]. Ascitic fluid aspirated from the SBP patients showed significantly lower transferrin and total protein values [p<0.05 and <0.001, respectively]. Serum: ascitic fluid transferrin ratio [mg/mg] was significantly lower in patients with SBP [p<0.001]. The best cut off level giving the highest diagnostic sensitivity and specificity was 3.5 yet, at this level poor diagnostic sensitivity and specificity in differentiating between the two clinical conditions [76% and 28%, respectively] was found. Ascitic fluid transferrin: ascitic fluid total protein ratio [mg/g] was significantly higher in patients with SBP [p<0.001] and had a diagnostic sensitivity and specificity of 100%, respectively in differentiating between both clinical conditions at a cut-off level of 22.26. Patients with advanced liver disease are more liable for the occurrence of SBP than SA. Ascitic fluid transferrin: ascitic fluid total protein ratio, at a cut-off level of 22.26, can differentiate between the two clinical conditions with a diagnostic sensitivity and specificity of 100%, respectively

Diabetic control, prokinetic drugs and gastroparesis diabeticorum

Gastric emptying time was investigated in 30 non insulin dependent diabetic patients [NIDD] using a non invasive technique; abdominal ultrasonography. They were subdivided into two groups, controlled diabetics [15 patients] and uncontrolled diabetic patients [15 patients]. Moreover, 10 apparently healthy subjects were included in the research as a control group. All patients had symptom[s] of gastroparesis [nausea, early satiety, vomiting etc]. The patients showed a significant delayed gastric emptying time when compared with healthy subjects, the mean of the latter is [3.3 +/- 0.3 hours]. The delay in gastric emptying is obvious in those with longer duration of diabetes mellitus, and is marked in the uncontrolled group [mean 5.4 +/- 0.7 hours] than the controlled diabetics [mean 4.1 +/- 0.3 hours]. Following domperidone administration for one month [one tablet 3-4 times a day]; gastric emptying time was shortened. That improvement was more significant in patients with uncontrolled diabetes [with much more delayed gastric emptying time] than those with controlled diabetes [with less delayed gastric emptying time] when either of them is compared to the normal healthy group. Inspite of significant improvement in symptom score after treatment, the total symptom score did not show significant correlation with improvement in gastric emptying time in the uncontrolled group denoting that symptoms of gastroparesis diabeticorum are not solely related to delayed emptying of the stomach and suggest that gastric dysrhythmia is to be considered in patients with long standing diabetes mellitus. Moreover, domperidone may restore the three cycles per minute gastric myoelectric activity rather than a prokinetic effect on gastric emptying rates