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Background: Liver diseases are major cause of mortality and morbidity worldwide. It is the 12th leading cause of death liver diseases can be classified as acute if the onset of symptom does not exceed six months or chronic if symptoms persist beyond this period. According to the recently available World Health Organization. The aim of study is to facilitate rational use of medicines. Methods: This study is a prospective, observational, single center study which include patients aged ?18 years, diagnosis of liver diseases with or without co-morbidities and is conducted at out-patient of Medicine department, Rajindra Medical College and Hospital, Patiala. Results: In this study, total of 97 prescriptions of patients with liver disease were analyzed. Out of 97 patients, the majority of patients were male. In ALD, males were 32 (78%) whereas female were 9 (22%) while in CLD males were 47 (84%) and females were 9 (16%).While observing the LFT profile of patients with ALD common tests were observed which includes total bilirubin (1.82�42), SGOT (96.81�7.49) and SGPT (94.78�2.94) and in patients with CLD common tests were observed which includes total bilirubin (2.50�63), SGOT (67.50�.04), SGPT (47.10�.12), blood urea (46.92�.14) and alkaline phosphatase (147.02�.14). Conclusions: The study interprets the prescribing pattern of drugs used in patients with ALD and CLD and observed that vitamins and minerals and antibiotics were the most prescribed in order to avoid further complications followed by hepatoprotective agents, antiulcer drugs, antihypertensives and laxatives.
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BACKGROUND The presence of cardiovascular dysfunction in liver cirrhosis has been studied over the past several years. Cardiovascular dysfunctions in cirrhosis increase the risk of coronary artery disease and mortality after TIPSS insertion and liver transplantation. Cirrhotic cardiomyopathy also plays an important role in the pathogenesis of hepatorenal syndrome. All these data highlight the need for rigorous cardiovascular risk assessment in patients with liver cirrhosis. METHODS After obtaining institutional approval, we analysed 96 consenting patients with liver cirrhosis satisfying inclusion criteria. Relevant history of the cases was sought through a structured questionnaire. Appropriate clinical examinations were done. Echocardiogram, ECG and biochemical parameters of the patients were examined and recorded. Data analysis was done using SPSS software. RESULTS 51% of the patients had QTc > 0.44 seconds in ECG which was suggestive of electrophysiological abnormality. The systolic dysfunction was assessed by presence of left ventricular ejection fraction below 55%, which was detected in 4.2% of the patients. E/A ratio less than 1 and deceleration time more than 200 msec were taken as parameters suggestive of the presence of diastolic dysfunction. 34.4% had an E/A ratio < 1 and 42.7% of the patients had a deceleration time more than 200 msec. 53% were found to have cirrhotic cardiomyopathy. The prevalence of CCM was increasing with the severity of liver disease. 53.1% of the patients had left ventricular hypertrophy and there was significant association between the prevalence of LVH and severity of cirrhosis. 38.5% of the patients had coronary artery disease as per history and ECG findings. No significant association was obtained between the prevalence of CAD and severity of CLD. 4.2% patients had arrhythmia and there was a significant association with the severity of disease. Troponin I was elevated in 20.8% of the patients. CONCLUSIONS Liver cirrhosis is a risk factor for cardiovascular dysfunctions. Most of the patients with cardiac compromise were asymptomatic. 53% patients were diagnosed to have cirrhotic cardiomyopathy. The prevalence of cardiovascular dysfunctions was found to increase with the rising severity of cirrhosis as per CTP score. Diastolic dysfunction was more prevalent than systolic dysfunction. The prevalence of cardiovascular dysfunctions was lesser among patients with regular follow-up and treatment for cirrhosis liver. 38.5% of the patients had coronary artery disease. The prevalence of arrhythmias was 4.2%. Troponin levels were elevated in 20.8% patients.
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Haematologic abnormalities are commonly encountered in chronic liver disease (CLD) due to hypersplenism occurred. Hypersplenism in CLD is a major cause of peripheral pancytopenia in patients with hepatic cirrhosis and portal hypertensive gastropathy and is characterized by splenomegaly. Peripheral pancytopenia is defined as a reduction in all three major constituents of the blood to below lower normal range, manifesting as anemia, leukopenia, and thrombocytopenia all occurring at the same time. We report an unusual case, a 44-year-old female patient, no splenomegaly, presented with severe anemia, leukocytosis and normal platelet which are rarely found in CLD.
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Haematologic abnormalities are commonly encountered in chronic liver disease (CLD) due to hypersplenism occurred. Hypersplenism in CLD is a major cause of peripheral pancytopenia in patients with hepatic cirrhosis and portal hypertensive gastropathy and is characterized by splenomegaly. Peripheral pancytopenia is defined as a reduction in all three major constituents of the blood to below lower normal range, manifesting as anemia, leukopenia, and thrombocytopenia all occurring at the same time. We report an unusual case, a 44-year-old female patient, no splenomegaly, presented with severe anemia, leukocytosis and normal platelet which are rarely found in CLD.
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Background: Liver Cirrhosis is the end-stage for chronic liver disease. Repeated course of endoscopy is recommended, as this intervention is expensive and often poorly accepted by patients, there is a need for non-invasive methods to predicts the progression of portal hypertension as well as the presence and size of esophageal varices. This study was aimed to assess the APRI and Transient Elastography for predicting esophageal variceal bleed in cirrhotic patients. Objectives of the study were to study Diagnostic accuracy of APRI for Prediction of esophageal variceal bleed in liver cirrhosis, diagnostic accuracy of Transient Elastography for Prediction of esophageal variceal bleed in liver cirrhosis, comparison of diagnostic accuracy of APRI and Transient Elastography for Prediction of esophageal variceal bleed in liver cirrhosis. Methods: It was a Single centre, observational study in 35 patients of chronic liver disease. Patients were included in the study after fulfilling inclusion and exclusion criteria. CBC, LFT, KFT, SE, viral marker, USG whole abdomen, UGIE, Transient Elastography was done. APRI was calculated for every patient. Results: The APRI and Transient Elastography showed moderate diagnostic accuracy in predicting the presence of esophageal variceal bleed. Transient Elastography performed better for prediction of esophageal variceal bleed. Conclusions: The APRI and Transient Elastography showed moderate diagnostic accuracy in predicting the presence of esophageal variceal bleed. They help in starting prophylactic therapy earlier to prevent the bleeding and other complications of varices. These non-invasive parameters can also play an effective role in conjunction with endoscopy in predicting the presence of esophageal varices.
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Background: Liver Cirrhosis is the end-stage for chronic liver disease. Repeated course of endoscopy is recommended, as this intervention is expensive and often poorly accepted by patients, there is a need for non-invasive methods to predicts the progression of portal hypertension as well as the presence and size of esophageal varices. This study was aimed to assess the APRI and Transient Elastography for predicting esophageal variceal bleed in cirrhotic patients. Objectives of the study were to study Diagnostic accuracy of APRI for Prediction of esophageal variceal bleed in liver cirrhosis, diagnostic accuracy of Transient Elastography for Prediction of esophageal variceal bleed in liver cirrhosis, comparison of diagnostic accuracy of APRI and Transient Elastography for Prediction of esophageal variceal bleed in liver cirrhosis. Methods: It was a Single centre, observational study in 35 patients of chronic liver disease. Patients were included in the study after fulfilling inclusion and exclusion criteria. CBC, LFT, KFT, SE, viral marker, USG whole abdomen, UGIE, Transient Elastography was done. APRI was calculated for every patient. Results: The APRI and Transient Elastography showed moderate diagnostic accuracy in predicting the presence of esophageal variceal bleed. Transient Elastography performed better for prediction of esophageal variceal bleed. Conclusions: The APRI and Transient Elastography showed moderate diagnostic accuracy in predicting the presence of esophageal variceal bleed. They help in starting prophylactic therapy earlier to prevent the bleeding and other complications of varices. These non-invasive parameters can also play an effective role in conjunction with endoscopy in predicting the presence of esophageal varices.
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Background: Chronic liver disease (CLD) is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism, as well as the synthesis of thyroid binding globulin. A complex relationship exists between thyroid and liver in health and disease. Methods: 103 patients of CLD were included in this study from December 2020 to September 2022. They were classified as per child Pugh scoring after clinical assessment and investigations. Thyroid function profile was measured for all the patients. Results: Among 103 patients, 8 (7.76%) patients were having overt hypothyroidism and 28 (27.18%) patients had subclinical hypothyroidism, while 67 (65.04%) patients had normal thyroid profile levels. There was significant correlation between CTP class and hypothyroidism status of patient (p value <0.001) with 25 (56.81%) patients of CTP class C having subclinical hypothyroidism, while 3 (7.5%) patients of CTP class B had subclinical hypothyroidism and none patient of CTP class A had subclinical hypothyroidism. Conclusions: Our study found that there was increased prevalence of subclinical hypothyroidism in CLD patients which increased with severity of CLD as assessed with CTP class.
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A variety of full 2ʹ-F/OMe-modified siRNAs were designed and synthesized, and the activity against hepatocellular carcinoma Huh-7 and HepG2 cells was evaluated. K&A DNA/RNA H-8 synthesizer was used to synthesize siRNAs, and neutral cytidinyl lipid DNCA mixed with cationic lipid CLD were used to transfect siRNA. By RT-qPCR and CCK-8 assay, the target gene silence and the proliferation of Huh-7 and HepG2 cells were detected. The siRNAs loading into Ago2 protein was detected by RNA-binding protein immunoprecipitation. Drug uptake and cell apoptosis were detected by flow cytometry, and the expression of PLK1 protein was detected by Western blot. Partial full 2ʹ-F/OMe modified siRNAs, especial siPLK1A3, increased the uptake of Huh-7 cells, enhanced their binding to Ago2 and gene silencing activity, down-regulated PLK1 protein, as well as induced more Huh-7 cell apoptosis and proliferation inhibition activity. It provides important data for the development of novel siRNA modification patterns and anti-HCC formulations.
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BACKGROUND: Thrombocytopenia refers to a reduction in platelet count below 1.5 lakh/microliter. The presence of thrombocytopenia in a hemogram should alert the physician to identify the underlying etiology for the prompt management of the patient. Timely identification and treatment prevent bleeding manifestations, requirement of platelet transfusions/steroids and overall impact on mortality of the patients. AIM OFSTUDY:Analysis to study the etiology, bleeding manifestation, percentage of patients requiring platelet transfusion, length of hospital stay in patients with thrombocytopenia. METHODOLOGY: 100 cases thrombocytopenia both male and female were included in the study. The diagnosis was made on peripheral smear and Hemogram. RESULTS: Dengue fever was the most common cause of thrombocytopenia with 43 cases. Sepsis with 23 cases was the second commonest. Bleeding manifestations were seen in 23% of the study population.100% of the patients with platelet count less than 10,000/microlitre had bleeding manifestations. 26 patients (26%) received platelet transfusion out of which 23 were therapeutic and 3 were prophylactic transfusions. Steroid therapy was given in 11% of patients. Mortality was highest in patients with sepsis induced thrombocytopenia. CONCLUSION:This study shows that Dengue fever is the commonest diagnosis made in patients who are detected to have thrombocytopenia. One fifth of patients with platelet count less than 1,00,000/microlitre tend to have bleeding manifestation, commonest being GI bleed, petechial rash and epistaxis. Majority of the bleeding occurs with platelet count less than 10,000. The proportion of patients receiving therapeutic platelet transfusion was higher compared to prophylactic transfusion.
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The aim of the present review is to have an in-depth analysis of the published scientific literature relating to the clinical use of ademetionine in various etiologies of liver disease. Literature search was performed using electronic databases like Pubmed/Medline/others to identify studies on ademetionine in patients with intrahepatic cholestasis, alcoholic liver disease, non-alcoholic fatty liver disease, drug induced liver injury and viral hepatitis. Ademetionine has been studied in various etiologies of liver disease with varying dosing and durations. In patients with chronic and alcoholic liver disease, ademetionine was found to be beneficial in improving liver enzyme levels, increasing glutathione levels, improving signs and symptoms of fatigue, pruritus and jaundice. Positive effects of ademetionine therapy have also been documented in multiple studies in patients with non-alcoholic fatty liver disease, with improvements observed in triglyceride, total cholesterol, alanine transaminase and asprtate transaminase levels and ultrasound grading of fatty change. In patients with drug induced liver injury, improvements were observed in liver biochemical markers and symptoms such as pruritus, fatigue and jaundice. Ademetionine has also been studied in patients with viral hepatitis with improvement in laboratory markers and signs and symptoms. Published data suggest that there is clinical evidence to substantiate the use of ademetionine across indications. Its use has resulted in sustained improvement in biochemical markers; signs and symptoms of liver disease has been observed in both acute and chronic liver disease. Further data is warranted through clinical studies to focus on specific end points of therapy areas, in existing and new indications.
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Background: Etiology of nearly 30% cases of chronic viral hepatitis remains undetected. Occult HBV infection (OBI) has emerged as an important clinical entity in this scenario. Apart from prevalence and clinical outcome of OBI patients genotype was determined in northern region of India. Materials and Methods: A total of 847 patients with chronic liver disease (CLD) were screened for common viral etiologies and others serological markers of HBV. Amplifi cation of surface, precore and polymerase genes of HBV was performed in patients negative for other etiologies. Genotyping and sequencing of the precore region was performed for OBI cases. Results: Twenty-nine (7.61%) cases of OBI were identifi edof which 9 had chronic liver disease (CHD), 11 liver cirrhosis (LC) and 9 hepatocellular carcinoma (HCC). Majority of OBI cases were detected by amplifi cation of surface gene 26 (89.6%), followed by pre-core gene 12 (41.3%). Their liver functions tests were signifi cantly deranged in comparison to overt HBV cases. IgG anti HBc was present in 8 (27.6%) OBI cases. Mutation was observed in 8 (32%) in pre-core region at nt. 1896 of overt HBV cases. Genotype D was the predominant genotype. In conclusion: OBI in our study was characterized by predominance of genotype D and more severe clinical and biochemical profi le in comparison to overt HBV. IgG anti HBc positivity could be utilized as a marker of OBI. We recommend use of sensitive nested PCR for diagnosis of OBI, amplifying at least surface and precore gene.
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RAS guanyl-releasing protein 3 (RasGRP3), a member of the Ras subfamily of GTPases, functions as a guanosine triphosphate (GTP)/guanosine diphosphate (GDP)-regulated switch that cycles between inactive GDP- and active GTP-bound states during signal transduction. Various growth factors enhance hepatocellular carcinoma (HCC) proliferation via activation of the Ras/Raf-1/ extracellular signal-regulated kinase (ERK) pathway, which depends on RasGRP3 activation. We investigated the relationship between polymorphisms in RasGRP3 and progression of hepatitis B virus (HBV)-infected HCC in a Korean population. Nineteen RasGRP3 SNPs were genotyped in 206 patients with chronic liver disease (CLD) and 86 patients with HCC. Our results revealed that the T allele of the rs7597095 SNP and the C allele of the rs7592762 SNP increased susceptibility to HCC (OR=1.55, p=0.04 and OR=1.81~2.61, p=0.01~0.03, respectively). Moreover, patients who possessed the haplotype (ht) 1 ( A-T-C-G) or diplotype (dt) 1 ( ht1/ht1) variations had increased susceptibility to HCC (OR=1.79 ~2.78, p=0.01~0.03). In addition, we identified an association between haplotype1 (ht1) and the age of HCC onset; the age of HCC onset are earlier in ht1 +/+ than ht1 +/- or ht1 -/- (HR=0.42~0.66, p=0.006~0.015). Thus, our data suggest that RasGRP3 SNPs are significantly associated with an increased risk of developing HCC.
Subject(s)
Humans , Alleles , Carcinoma, Hepatocellular , GTP Phosphohydrolases , Guanosine Triphosphate , Haplotypes , Hepatitis B virus , Intercellular Signaling Peptides and Proteins , Liver , Liver Diseases , Phospholipase C gamma , Phosphotransferases , Polymorphism, Single Nucleotide , Polyphosphates , Signal TransductionABSTRACT
PURPOSE: This study was designed to see the BP changes according to the time course and the duration of dexamethasone (DXM) therapy in premature infants with chronic lung disease (CLD). METHODS: We studied 27 chronic lung disease patients treated with DXM in NICU, Chonnam University Hospital from January 1994 to May 1998. Systolic, diastolic, and mean arterial pressure were recorded at three times (8 AM, 4 PM, midnight) daily. Data were analyzed by time peroid : Pre DXM means 14 days before DXM therapy, DXM during the therapy and Post DXM 14 days after the completion of therapy. Of 27 patients, 16 received short-course (7 days), and 11 long-course therapy (42 days). RESULTS: Mean gestational age of the patients was 29.3 (+/-1.5) weeks and the mean birth weight was 1,169 (+/-262) gm. Systolic, diastolic and mean BP were significantly increased during the DXM therapy compared to pre DXM (76+/-7 mmHg vs 67+/-9 mmHg, P<0.001, 44+/-6 mmHg vs 38+/-6 mmHg, P<0.001, 55+/-6 mmHg vs 49+/-7 mmHg, P<0.001, respectively). Even 14 days after the completion of therapy, systolic, diastolic and mean BP were not decreased to the level of pre DXM therapy. The maximal increase of BP was noted on the second day of treatment. When the BP changes were compared according to the duration of therapy, post DXM BP was decreased to the level of pre DXM in short course, but not in long course group with the higher post DXM systolic BP than that of short course group (78+/-11 mmHg vs 69+/-7 mmHg, P<0.05). CONCLUSION: BP significantly increased during DXM therapy, particularily on the second day of treatment. Also our result suggests that we have to watch the BP carefully more than two weeks after the completion of therapy.