Anti-cyclic citrullinated peptide antibodies as a discriminating marker between rheumatoid arthritis and chronic hepatitis C-related polyarthropathy

Articular involvement is a frequent extrahepatic manifestation of hepatitis C virus infection. The distinction between HCV-related polyarthropathy and true RA may be very difficult especially with recent onset RA before articular damage and erosions develop. To assess the diagnostic utility of anti-CCP antibodies and compare it with that of rheumatoid factor in distinguishing between rheumatoid arthritis and HCV related polyarthropathy. Anti-CCP antibodies and RF were determined in the sera of 30 patients with RA and 22 patients with HCV-related polyarthropathy. Anti-CCP antibodies were positive in 83.3% of patients with RA and in 4.5% in patients with HCV and polyarthropathy. RF was positive in 90% of RA patients and in 81.1% of HCV patients with polyarthropathy. The anti-CCP antibodies showed higher specificity for RA compared to RF [95.4% Vs 18.2%]. However the sensitivity of anti-CCP was comparable to that of RF [83.3% Vs 90%]. Anti-CCP antibodies are reliable laboratory markers to differentiate between RA and HCV-related polyarthropathy

Validity of platelet count/spleen diameter ratio as a predictor of esophageal varices in patients with liver cirrhosis

Portal hypertension commonly accompanies the presence of liver cirrhosis, and the development of esophageal varices [OV] is one of the major complications of portal hypertension. To evaluate platelet count/splenic size ratio as a non-invasive parameter to predict the presence or absence of esophageal varices in patients with liver cirrhosis. Eighty-six cirrhotic patients who underwent digestive upper endoscopy, were classified into Group 1 which is formed of 60 patients who had endoscopic evidence of OV and Group 2 which is formed of 26 patients who had no endoscopic evidence of OV. All the patients underwent thorough clinical examination, laboratory and ultrasonographic evaluation. Laboratory investigations were done in the form of complete blood count including platelet count [PLT]; liver function tests [aspartate transaminase [AST], alanine aminotransferase [ALT], serum bilirubin and prothrombin time [PT]], schistosomal antibodies, hepatitis B surface antigen [HBsAg] and hepatitis C virus antibodies. Abdominal ultrasonography and upper gastrointestinal endoscopy were done for all patients. Patients with OV had lower mean platelet count and higher mean spleen diameter than patients without OV [p=0.003 and p=0.01 respectively]. The mean values of the ratio of platelet count/spleen diameter was significantly lower among OV group when compared with patients who had no endoscopic evidence of OV [p=0.002]. There was no significant difference in the platelet count/spleen diameter ratio between different grades of OV. Large OV was associated with increased portal vein diameter [p=0.05]. Lower platelet count/splenic size ratio is associated with the presence of OV yet it cannot be used as a predictor of OV and so the endoscopy remains the standard screening test for OV among patients with liver cirrhosis

Pregnancy outcome in two different social classes

The present study was directed to correlate pregnancy outcome by social class. A sample of 765 recently delivered mothers were chosen randomly representing two different social classes. Unfavourable outcome of pregnancy was found to be more prevalent among low income, illiterate mothers with high parity, older age and defficient antental care. Also among mothers suffered from bleeding, toxaemia, kidney disease and past unfavourable outcome of pregnancy