ABSTRACT
Background: Hepatitis C is a leading cause of liver fibrosis, cirrhosis, and cirrhosis associated complications. In this study, we compared readily available non-invasive fibrosis indexes with fibro scans for fibrosis staging and predicting its progression in Pakistani population. Methods: The retro prospective cross-sectional study was conducted in medicine unit 1 and 2 and hepatitis clinic of Lahore General Hospital, Lahore starting from February 12, 2018 to January 8, 2019. We studied 1464 HCV infected patients which were got CBC, LFTs, ELISA, PCR and fibro scan was done to perfectly diagnose ongoing hepatitis C infection. In order to differentiate HCV fibrosis progression, we compared the effectiveness of readily available AST to Platelet Index (APRI), and FIB-4 with fibro scan. Results: Readily available serum indexes AST to Platelet Index (APRI) and FIB-4 were able to stage liver fibrosis in advanced stages of fibrosis (F4 especially) with correlation coefficient indexes 0.462, and 0.131 with considerable specificities and sensitivities. For APRI >1.5, it did predict F4 stage with sensitivity of 87.6% and specificity of 74.8%. For Fib-4> 3.25, it did predict F4 stage with sensitivity of 72.3% and specificity of 53.2%. Conclusion: Readily available and cheap serum indexes, AST to Platelet Index (APRI) and FIB-4 accurately predicted distinguished between cirrhotic and non- cirrhotic stages in HCV infected patients in comparison to the costly and rarely available Fibro scan score.
ABSTRACT
Background/objectives: The aim of our study was to review the safety and effectiveness of Endoscopist-directed nurse-administered propofol sedation (EDNAPS) during GIT endoscopic procedures, occurrence of major and minor adverse events followed by propofol sedation, level of patient satisfaction and possible choice of propofol as sedative agent in their future endoscopic procedures in Pakistani population. Materials and methods: Prospective data were collected from patients receiving diagnostic AGD, colonoscopy or ERCP. Subjects who stopped the emergency procedure or both EGD and colonoscopy were excluded on the same date. Other exclusions include over 20 years of age, pregnancy, the American society of associate psychologists (ASA) Class III or IV, overweight (body weight>100kg), or drugs or its components or components (Soybean or egg) allergies included. Result: In our study a total of 929 patients comprising 520 males (56%) and 409 females (44%) with mean age of 46.19 ± 15.3years, mean MBI 24.27 ± 2.7. Age-specific propofol dosage was similar across gender except for age group 60 years and above where higher mean propofol dosage was required for females as compared to males for EGD and Colonoscopy (82.8 ± 32.2 vs. 63.5 ± 29.8; p-value 0.005; 81.1 ± 26.1 vs. 75.3 ± 25.0; p-value 0.03). The required examination was completed in all cases. There was no major adverse event. Majority of the patients rated the procedure satisfactory and agreed to undergo same sedative for next time. Conclusion: Endoscopist-directed nurse-administered propofol sedation (EDNAPS) during GIT endoscopic procedures is safe and effective in selected patients.