ABSTRACT
Introduction: Spontaneous Bacterial Peritonitis (SBP) iscommon and serious complication of patients with livercirrhosis and ascites, without an apparent surgically treatableintra abdominal source of infection. Its prevalence rangesfrom 10% to 30%. Mortality rate was earlier reported morethan 90%, but it has now reduced to 30% -50% as a resultof rapid diagnosis and prompt initiation of antibiotics. Thepresent study was done to evaluate the various non culturemethods for the diagnosis of SBP.Material and Methods: Ascitic fluid sample were collectedaseptically from 100 cirrhotic patients with ascites. PMN(polymorphonuclear leukocyte) count was determined byNeubauer’s manual counting chamber and Leishman’s stainfor differential PMN cell counts. Granulocyte esterase activitywas detected using LER (Leukocyte esterase reagent) dipstickstrips.Results: Out of 100 samples processed, PMN cell count >250 cells/mm3 was found in 91% samples by conventionallight microscopy. Scale of > 2+ by LER strip was found in61 samples. Reading of PMN cell count of > 250 cells/mm3matched in 60 samples and < 250 cells/mm3 matched in 8 cellsby both microscopy and LER strip test. Sensitivity, specificity,positive predictive value and negative predictive value ofLER strip test was 65.9%, 88.89%, 98.36% and 20.51%respectively.Conclusion: LER strips as a screening tool for SBP haveadvantage of speed, low cost, availability at odd hours, requiresno technical expertise and can be performed everywhere.Its high specificity and PPV may help in early institution ofempirical antibiotic therapy in patients.
ABSTRACT
Background: Cirrhosis is a relatively common disease in Vietnam and many other countries. Cirrhosis develops slowly and affects the labour power and the ability of the patient\u2019s living. So it is necessary to detect and treat timely. Objectives: To evaluate some coagulation factors in cirrhotic patients and learn the relationship between coagulation and cirrhosis. Subjects and method: A descriptive, cross sectional study of various coagulation factors was conducted on 72 patients with cirrhosis in the Gastrointestinal Department of Thai Nguyen Central General Hospital from July 2007 to April 2008. The data was collected and analysedby medical statistic based on SPSS 10.0 software. Results: The proportion of haemostatic disorder with low platelet count was up to 50%. Chid-Pugh C group was the most decreased platelet group compared to Chid-Pugh A and Chid-Pugh B group. About coagulation disorder: prolonged APTT accounted for 12.5% and its increase corresponded with the seriousness of the disease; fibrinogen deficiency <2g/l was observed in 20.8% of the patients; the rate of prolonged prothrombin time was 54.2%; INR>l.7 was 19.4% of the patients and it increased gradually from mild to serious cirrhosis groups. DIC patients accounted for 29.2% of the subjects; among which, the rate of DIC in Chid A, Chid B, and Chid C groups were 10.5%, 25%, and 44.8%, respectively. Conclusion: The results proved that there was a close relationship between coagulation disorder and cirrhosis level.
Subject(s)
Blood Coagulation FactorsABSTRACT
116 sera from cirrhotic patients were tested for HbsAg, Anti-HCV and Anti-HIV to assess the prevalence and determine risk factors of virus acquisition. Forty-two patients (36.21%) were positive for HbsAg, thirty patients (25.86%) were positive for Anti-HCV, five patients positive both HbsAg and Anti-HCV and only one patient (0.86%) was positive for Anti-HCV. There is no statistically different between risk factors (IVDU, prostitute, units of blood transfusion) and positity of viral markers, but alcohol seems to be less in HbsAg positive patients (p < 0.0001). For HIV the prevalrnce is comparable to general populations there is no need for routine Anti-HIV examination in cirrhotic patients with bleeding esophageal varices, but universal precaution is still the rule.