ABSTRACT
Psychiatric disorders are common comorbidities in patients with liver cirrhosis that may impair patients' quality of life. The purpose of this study was to evaluate the common psychiatric disorders in cirrhotic patients in our locality. Subjects and Psychiatric disorders were prospectively assessed by administration of Symptom Checklist-90 revised [SCL-90-R], Hamilton anxiety rating scale, and Hamilton Checklist of Symptoms of depressive illness to 200 patients with liver cirrhosis and 200 control volunteers of matched age. In addition, clinical data, abdominal ultrasonography and laboratory data [liver function tests for patients] were collected. Results. Compared with controls, cirrhotic patients were significantly more likely to have depression [43.5% versus 14%, P< 0.001], anxiety [16.5% versus 5.5% P< 0.001] and increased mean scores of SCL-90-R subscales ['e.g. somatizalion, depression and hostility,]. Increasing severity of liver cirrhosis [based on the Child-Pugh score] was associated with increased frequency of Psychiatric disorders. Compared with the control group, patients with liver cirrhosis showed significantly higher frequency of comorbid psychiatric disorders which is increased by worsening disease severity
ABSTRACT
In 1997 Transfusion Transmitted Virus [TTV] was isolated from the serum of a patient with post transfusion hepatitis of unknown etiology, in Japan. It's considered as a causative agent of non A to G hepatitis. To assess the prevalence of TTV infection among patients with liver diseases compared with healthy controls and the significance of TTV infection in patients with liver disease. This investigation was conducted on 76 patients with liver diseases, classified into four groups: Acute hepatitis group [20 patients], chronic liver diseases [30 patients], Liver cirrhosis [18 patients] and hepatocellular carcinoma [8 patients]. In addition to the patient groups, the fifth group of 24 healthy blood donors as control group was included within the study. All patients and control groups were examined for the detection of TTV DNA by PCR. Thirty seven had history of blood transfusion and 23 patients were subjected to surgical manipulation. TTV DNA was detected in 57.9% [44/76] of patients with liver diseases and in 45.7% [11/24] of healthy blood donors. The prevalence of TTV in the studied groups were 60%, 46.7%, 66,7% and 75% in acute hepatitis, chronic liver diseases, liver cirrhosis and hepatocellular carcinoma respectively. TTV is commonly present in patients with liver disease attended to Assiut University Hospitals as well as in blood donors. High prevalence of TTV in blood donors may indicate other routes of transfusion of this virus such as fecal-oral and sexual routes beside transfusion of blood and blood products. The blood transfusion and operative intervention are a major risk factor for transmission of TTV
Subject(s)
Humans , Male , Female , Torque teno virus , Blood Transfusion/adverse effects , Prevalence , Hospitals, University , Polymerase Chain ReactionABSTRACT
Spontaneous bacterial peritonitis [SBP] in cirrhotic patients is associated with an increased production and decreased metabolism of inflammatory mediators [cytokines] such as tumour necrosis factor a [TNF-alpha], interleukin 6 [IL-6] and interleukin 1-beta [IL-l beta]. The present study was designed to investigate the relationship between the development of SBP and the degree of inflammatory response in patients with liver cirrhosis and to assess the diagnostic value of the inflammatory mediators in cirrhotic patients with SBP. This study was carried out on 46 cirrhotic patients with SBP, 22 cirrhotic patients with ascites but without evidence of SBP, and 12 healthy subjects as a control group. All patients were subjected for history taking, clinical examination and abdominal ultrasound. Blood samples were collected for complete blood count [CBC], liver function tests and measurement of TNF-alpha, IL- l beta, and IL-6 levels [in patients and control]. Ascitic fluid samples were collected for measurement of TNF-alpha, IL- l beta, and IL-6 and for aerobic and anaerobic cultures [only in patients with SBP]. Cirrhotic patients with SBP showed significantly higher plasma and ascitic fluid levels of TNF-alpha, IL- l beta and IL-6 than cirrhotic patients without SBP [despite that severity of liver disease was similar in the two groups] and normal control subjects [p<0.001]. Ascitic fluid TNF-alpha, IL- l beta and IL-6 were also higher in the cirrhotic patients with SBP than in plasma, [p<0.001 for each]. Also the plasma levels of TNF-alpha, IL- l beta and IL-6 in cirrhotic patients with SBP were significantly higher than in healthy control subjects [p<0.001]. There was a strong direct correlation between plasma and ascitic fluid levels of TNF-alpha, [r=0.9624, p<0.001] IL-l beta [r=0.4024, p<0.01], and IL-6 [r=0.2890, p<0.05] at the time of diagnosis of SBP. A significant correlation was also observed between TNF-alpha, IL- l beta, and IL-6 in ascitic fluid [r=1.0000, p<0.001] and in plasma [r=0.8500, p<0.001]. PMN cell count in ascites correlated significantly with the ascitic fluid level of IL- l beta [r=0.3156, p<0.05], but did not correlate with both TNF-alpha [r-0.0953, p>0.05] and IL-6 [r=0.0702, p>0.05]. Patients with culture-positive SBP showed significantly higher plasma and ascitic fluid levels of TNF-alpha, IL- l beta, and IL-6 than patients with culture-negative SBP. The PMN cell count in the ascitic fluid was also significantly higher in the culture-positive vs culture-negative SBP patients [6.813 +/- 0.24 vs 1.36110.07, p<0.001]. Cirrhotic patients with SBP display a marked increase of TNF-alpha, IL- l beta, and IL-6 levels in ascitic fluid and plasma. Specificity and sensitivity of these cytokines detection of SBP in cirrhotic patients strongly favor its measurement during acute phase of the disease