Antihyperglycemic effect of methanol extract of Tamarix aphylla L. Karst (Saltcedar) in streptozocin–nicotinamide induced diabetic rats

Objective To evaluate the antihyperglycemic potential of Tamarix aphylla (T. aphylla) leaves in STZ–NIC induced diabetes in Wister Albino rats. Methods Acute toxicity study was done to check the toxicity of T. aphylla (L. Karst) methanol extract. T. aphylla leaves extract was administered intraperitoneally (100 mg, 250 mg and 400 mg/kg body weight per day) to diabetic Wister rats for 21 days. The various parameters were studied including fasting blood glucose levels, haemoglobin and glycosylated haemoglobin. Results The treatment groups with the extract at three dose levels expressively abridged the intensities of blood glucose and Glycosylated Haemoglobin. The earlier detected reduced level of plasma haemoglobin of the diabetic rats was raised to near normalcy with treatment of extract. Conclusions The results of the current study confirm that the leaves extract of T. aphylla are nontoxic and have antidiabetic nature.

Evaluation of hepatotoxic and nephrotoxic effects of piroxicam sulfonated derivatives

Background: Pain management requires new pharmacotherapy with good efficacy and less side effects. Piroxicam is used routinely in clinical practice but it is associated with side effects. To minimize the chances of adverse effects, sulfonated piroxicam derivatives [SPD] have been introduced. We sought to find hepatotoxic and nephrotoxic effects of SPD in Albino rats

Methods: An experimental study on SPD was carried out at the Institute of Basic Medical Sciences, Khyber Medical University, Peshawar. Healthy 24 albino rats were divided into 5 groups. One control group and four experimental groups [compound I and II, each with a dose of 10mg/kg and 20mg/kg] received treatment for 7 days. Liver function tests [LFTs], renal function tests [RFTs] and histology of liver and kidney specimens was performed after culling rats. The difference between median values of samples was assessed using Kruskal-Wallis test with post-hoc [for LFTs and RFTs]. SPSS-21 was used for all statistical analysis and p?0.05 was considered statistically significant

Results: The alanine aminotransferase [ALT] values were significantly high in the 20 mg/Kg group than control for both compounds [p=0.03, p=0.001 respectively]. The aspartate aminotransferase [AST] values were significantly high in the 10 mg/Kg and 20 mg/Kg group than control for compounds II [p=0.01, p=0.0001 respectively]. The alkaline phosphatase [ALP] values were significantly high in the 20 mg/Kg group than control for compounds II [p=0.002]. The blood urea values were significantly high in the 20 mg/Kg group than control for compounds II [p=0.008]. The mean final score of liver injury in all experimental groups [mean range 5-7] was less suggesting that the damage in liver was less pronounced. Renal injury was more pronounced in the 20 mg/Kg dose for both compound I and compound II [mean score 7] compared to 10 mg/Kg dose [mean score 4]

Conclusion: Piroxicam sulfonated derivatives can cause focal changes in liver and kidney which might be reversible. The changes are less pronounced for compound I with a low dose

Comparative evaluation of conventional medical treatment alone versus conventional medical treatment with amniotic membrane transplantation in infective corneal ulcer

To compare the effect of amniotic membrane transplantation along with conventional therapy and the conventional therapy alone for the treatment of infective corneal ulcer. This study was conducted at Ophthalmology Department, Hayatabad Medical Complex Peshawar. The duration of study was 6 months, i.e., from April 2010 to October 2010, in which a total of 68 patients were included using WHO software for sample size determination. They were divided into two equal groups of 34 each. Non probability purposive sampling technique was used. In this study, mean age was 50 +/- 0.24 years. Forty six [67.6%] patients were male while 32.4% [n=22] patients were female. Conventional Medical Treatment alone was effective in 87% [n=30] cases while Conventional Medical Treatment with Amniotic Membrane was effective in 96% [n=33] cases with a p-value of 0.03. This study showed encouraging results of amniotic membrane trans plantation along with conventional treatment in corneal ulcer in improving both symptoms and signs

Successful intubation with air-Q in Pierre Robin syndrome

Airway access is particularly difficult in infants and children with some anatomical deformities, usually associated with congenital syndromes. Craniofacial abnormalities are commonly seen in the Pierre Robin Syndrome [PRS], Treacher Collins and Goldenhar syndromes. The Pierre Robin sequence consists of micrognathia and relative macroglossia with or without cleft palate. In the severe case, airway obstruction and feeding difficulties are present. Endotracheal intubation may be difficult, or in some case even impossible. We present a case report of intubation of a child, suffering from PRS, by using air-Q, a new intubating LMA, and use of tongue stitches to maintain airway during recovery

Validated spectrofluorimetric method for determination of sulpiride in commercial formulations using Hantzsch condensation reaction

A simple, sensitive, selective and cost effective spectrofluorimetric method has been established for the quantification of sulpiride after their complete alkaline hydrolysis. The method is based on the condensation of the primary amino group of alkaline hydrolytic product of sulpiride with acetyl acetone and formaldehyde in acidic medium [0.25 M HCl] to form a fluorescent product. The reaction product formed shows maximum fluorescence intensity at 483 nm after excitation at 431 nm. The different reaction conditions influencing the condensation reaction were carefully optimized and a linear range of 0.1-3.5 micro g mL[-1] with good correlation coefficient between florescent intensity and concentration of sulpiride was found at optimum parameters. The LOD and LOQ were found to be 11 and 39 ng mL[-1] respectively. The proposed method was successfully used for the quantification of sulpiride in bulk powder and commercial formulations. The effect of common pharmaceutical excipients and co-administered drug was also studied and no interferences were observed. The validity of the method was tested by analyzing sulpiride in bulk powder, and pharmaceutical formulations through recovery studies. Recoveries [%] were obtained from 98.62 to 100.24% for bulk powder, and 97.09 to 100.57% for commercial formulations. The results were validated statistically with those obtained by reference literature high performance liquid chromatographic method

Histopathological spectrum of gastric biopsies in a tertiary care hospital

This study was carried out to determine the histopathological spectrum of gastric lesions at a tertiary care hospital. A retrospective study. This study was conducted at Dr. Tahir Laboratory from Gastroenterology unit of Hamdard University Hospital Karachi from July 2009 to August 2012. The gastric mucosal biopsies of 280 patients received at Dr. Tahir Laboratory from Gastroenterology unit of Hamdard University Hospital Karachi. A slight higher frequency of gastric disease seen in females with age range of 17 years to 78 years was observed. The clinical presentations mostly seen were abdominal pain, dyspepsia, vomiting, diarrhea, decreased appetite and weight loss. The histopathology revealed chronic active gastritis [H Pylori positive and negative] followed by malignant gastric ulcer. A number of biopsies were unremarkable histologically. The more prevalent lesions in this series were chronic active gastritis. H. pylori associated gastritis was seen in majority of the patients. Thus gastric biopsy is an essential tool for diagnosis and confirmation of clinically suspected cases

Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan

To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center. This observational study was conducted at Children Hospital Quetta [CHQ] from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot [Trade Mark] tests were performed for the diagnosis of Typhoid fever in the suspected populations. Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 [18.6%] patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis. The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever

Unusual presentation of Crohn's Disease

Objective of reporting this unusual case of Crohn's Disease is twofold. Firstly in western literature there appears to be an impression that it is very rare condition in Asian countries, although it perhaps is true but the fact remains that it does exist here both in children and adults. Main reason why it does not get detected, may be that because it gets drowned in the overwhelming prevalent tuberculous disease in our country as the symptoms in two conditions are somewhat similar. Second reason for reporting this case is the symptoms in this patient were predominantly gastrointestinal bleeding requiring several transfusions, which is not a predominant presenting feature in Crohn's disease

Quantification of sparfloxacin in pharmaceutical dosages and biological samples

A simple and fast method for spectrophotometric determination of sparfloxacin using p-dimethylaminobenzaldehyde [DMAB] has been developed. A yellow coloured product formed from reaction between sparfloxacin and DMAB as a result of condensation reaction at room temperature. The maximum absorbance was found at 392 nm with molar absorptivity of 4.9 × 10[3] L mol[-1] cm[-1]. All parameters for the reaction, as concentration of DMBA reagent, molarity of sulphuric acid, and reaction temperature were studied. Under the conditions studied, a linear relationship between absorbance of the condensation product and concentration of sparfloxacin in the range of 2.0-80.0 microg m[E1] was found with good correlation coefficient [0.9997]. The limits of detection [LOD] and quantification [LOQ] for the proposed method were found to be 0.22 and 0.75 microg m[E1] respectively. The repeatability and accuracy [model] of the method was studied at three different concentrations of sparfloxacin and found with value of relative standard deviation less than 2.0%. The method was found selective for determination of sparfloxacin in the presence of commonly used excipients in dosage forms. The developed method was validated statistically and applied successfully to the analysis of the drug in pure form, pharmaceutical preparations, and spiked blood plasma and urine samples with good accuracy [real] and precision. The percentage recovery was found from 99.0-100.0% with relative standard deviation less than 1%. The results of the proposed method were compared statistically with the results of literature HPLC method

Significant high lipid profile in pre-hypertensive subjects as compare to stage 1 and stage 2 of hypertensive subjects

To analyze the differences in lipid profile in various categories of hypertension in our local population. Cross Sectional Study. This study was conducted at Amin Hayat Memorial Trust for diabetes and Hypertension, Lahore and Punjab Institute of Cardiology [PIC], Lahore from Dec. 2005 to May 2007. A total of 510 subjects of either sex were screened during a cross-sectional study. Biochemical assessment includes the determination of TC [Total Cholesterol], LDL-C [Low Density Lipoprotein Cholesterol], HDL-C [High Density Lipoprotein Cholesterol], and TG [Triglycerides], which were measured by using commercially available kits using Hitachi 902 photometer. vLDL and LDL-C/HDL-C ratio was calculated by using formula. Abnormal lipid profile was observed in 59% of the study population. Around 75% of prehypertensive subjects had abnormal lipid profile as compare to stage 1 and stage 2 of hypenension. Beside prevalence significant high levels of TC, LDL-L, and LDL-C/HDL-C were also observed in prehypertensive group. Females had significantly high levels of TC, HDL-C and LDL-C/HDL-C compared to males. A high prevalence of dyslipidemia was observed in all stages of hypertension; however, prehypertensive group had significant high levels of lipid profile and smoking and family history also predispose to high blood pressure

Analysis of changes in intraocular pressure with changes in body position

To find out the patterns of changes in Intraocular Pressure [IOP] with changes in body position, both in the sitting and lying position. This descriptive study was conducted at Hayatabad Medical Complex, Peshawar from October 2010 to March 2011. All the individuals who voluntarily consented were included in the study. These include individuals without any eye pathologies, glaucomatous eyes, eyes with cataract and both hospitalized and non-hospitalized individuals. While all the individuals who have any corneal pathologies, uveitis, detachment, post operative and post lasered eye were excluded from the study. All the patients were examined with slit lamp. Then Per kins' hand-held applanation tonometer was used to measure the IOP both in the sitting and lying position. The proforma was then filled and data was analyzed by using SPSS v.17. A total of 100 volunteers were included in our study while total number of eyes were two hundred. The mean age of the sample was 49 +/- 15.4 years. There were 110[55%] males and 90[45%] females. Hypertension was present in 50[25%] patients and all of them were taking ant ihyper tensive medications. Thirty five [17.5%] were diabetic and were also on medications. The mean IOP in the sitting position was 13.28 +/- 3.6 mmHg and in lying position it was 16.4 +/- 3.9 mmHg. The difference between lying and sitting position was 3.12 +/- 0.3 mmHg [p<0.001]. A postural IOP change can occur when an individual changes its position from sitting to supine position. Intraocular pressure increases in the lying position as compared to the sitting position

Percutaneous nephrolithotomy for the treatment of renal stones larger than 2.5 CM

To share our experience regarding the safety and efficacy of Percutaneous Nephrolithotomy for the treatment of renal stones of larger than 2.5 cm and to study the frequency of any postoperative complications associated with this procedure. This is a descriptive study conducted during the period from June 2007 to December 2009. Using non-probability convenient sampling, total 88 patients with renal stones of more than 2.5 cm were selected for PCNL. Data was analyzed on SPSS version 10 for windows XP. In a cohort of 88 patients [57 male and, 31 female] PCNL was performed for renal stone treatment. The mean age was 33.5 [9 - 65] years. The mean operative time was 85 [60 - 180] minutes and the mean stone size was 3.2 cm range [2.5-4.8] cm. There were 37 staghorn and 51 non staghorn stone. PCNL via a single access tract was accomplished in 86% [76/88] of procedures, with upper pole calyx in 30, middle calyx in 27 and lower pole calyx in 19 procedures, while multiple tracts were used in 14% of procedures [12/88] with 09 procedures using the upper and middle calyxes and 05 procedures using lower and middle calyxes. The stone-free rates for staghorn stone at discharge and at 3 months were 83.7% and 90.8% respectively, while for non staghorn stone the figures were 85.8% and 92.5% respectively. Postoperative complications were observed in 9% of the procedures [8/88], the commonest of which was bleeding necessitating blood transfusion in 4 patients. PCNL is safe and Effective treatment for renal calculi associated with less morbidity, shorter hospital stay and is cost effective

audit of the mortality due to severe head injuries in a neuro-surgical intensive care unit

To analyze the data of patients died in neurosurgical intensive care unit due to severe head injuries. This retrospective study was conducted in neurosurgical intensive care unit in Lady Reading Hospital, Peshawar from January to December 2007. The Clinical record of all the patients presenting with severe head injuries, who then expired in neurosurgical intensive care unit was collected. The record was analyzed accordingly for discussion and recommendations. Out of 112 patients, majority were young adults [n=64, 57.14%] followed by children [n=34, 30.35%] and elderly [n=10, 8.92%]. Road traffic accidents were the major cause of presentation [n=75, 66.96%] followed by history of fall [n=23, 20.53%] and fire arm injuries [n=13, 11.60%]. The correctable surgical causes were present only in 18 patients [16.07%] and the majority 94 [83.92%] were given conservative management. Among the non-surgical cases, both ventilatory therapy in 7 [6.25%] and tracheostomy in 39 [34.82%] patients failed to change the outcome. Road traffic accident was the major contributor in the mortality in patients presenting to neurosurgical intensive care unit. Most involved were young adults

Frequency of headache with stress in adolescent and young adults

Objective of this study was to establish a link between stress as a cause of headache in young adults. Cross sectional study. Department of Neurology Military Hospital [MH] Rawalpindi from September 2009 to March 2010. Thirty young patients, referred for the complaints of headache to the Neurology out patient department, were included in this study. A detailed especially designed, pre tested headache questionnaire was devised which was filled for every patient individually included in the study. Twenty One [70%] of the patients in the study group did have the feeling of stress preceding the headache which sometimes persisted during the episode. Nine [30%] did not report any such feeling of stress before or during the episode. Out of the patients reporting stress 71% [15] were female patients and 29% [6] were males. These key findings suggest that stress and headaches may be related for adolescents and young adults and that this relationship may be reinforced over time. Moreover female patients were far more susceptible to this stressful stimulus as compared to the males

Report of a recurrent mutation in ARS [component B] gene with severe Mal de Meleda in a large consanguineous Pakistani family

To characterize the disease causing mutation in a large consanguineous Pakistani family with severe Mal de Meleda [MDM] or keratosis palmoplantaris transgrediens, a rare autosomal recessive skin disorder. Single nucleotide polymorphism [SNPs] genotyping was performed using the GeneChip Mapping 250K array [Affymetrix]. Homozygosity mapping and sorting of genomic regions were performed with dedicated software called AutoSNPa. Selected regions were further investigated by genotyping with microsatellite markers derived from known and novel polymorphic repeats. Two-point LOD score calculation was performed by using the MLINK of Fastlink computer package. All three coding exons of ARS [component B] gene were amplified by PCR and sequenced. Sequencing of all the coding exons of ARS [component B] gene in the affected individuals revealed a recurrent missense mutation in exon 3 at base pair 256 from Guanine to Alanine [256G>A] and as a result the amino acid Glycine is replaced by Arginine at position 86 [G86R]. This finding will facilitate control of affected MDM births in the Pakistani families

Risk Factors and Phenytoin Prophylaxis for Early Post-Traumatic Seizures among Patients with Traumatic Brain Injury

Background: Post-traumatic seizure is a well-known and serious complication of traumatic brain injury (TBI). The incidence and risk factors vary among study populations. Very little data have been published concerning this in the Malaysian population. The aim of this study was to ascertain the risk factors for the development of early post-traumatic seizures among patients with TBI. Methods: This was a prospective observational study, carried out in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, under the Department of Neurosciences. A total of 157 patients, from all age groups, who were diagnosed with TBI were enrolled from June 2007 to December 2007. They were followed-up for 12 months until death or their first post-traumatic seizure. Survival analysis with Kaplan–Meier curves and Cox proportional hazards regression was performed. Results: A total of 11 (7.0%) of the patients developed early post-traumatic seizures. The risk factors for early post-traumatic seizures were young age (P = 0.021, 95% CI 0.806 to 0.982) and intubated patients (P = 0.029, 95% CI 1.194 to 25.913). The incidence of early post-traumatic seizures in the local population was 7.0%. Conclusion: The incidence of early post-traumatic seizures in the local population of Kelantan and Terengganu is comparable to the incidences reported elsewhere. Younger as well as intubated patients were at a higher risk of developing this condition. It may be necessary to give antiepileptic prophylaxis because any seizure could adversely affect morbidity and mortality. However, the study showed that antiepileptic drug was not beneficial in preventing late post-traumatic seizures, but may have a role in preventing early seizures.

Helicobacter pylori infection in patients with dyspeptic symptoms having normal endoscopy

To find out the frequency of Helicobacter pylori infection in the local population presenting with dyspeptic symptoms but having normal upper gastrointestinal endoscopic findings. This descriptive study was carried out in gastroenterology department of Military Hospital Rawalpindi. The study was conducted in the department of gastro intestinal of Military Hospital Rawalpindi from November 2004 to September 2005. Hundred cases of dyspepsia having normal upper gastrointestinal endoscopy were taken as study population. Although the gold standard for presence or absence of Helicobacter pylori infection is culture but in this study the diagnostic method used was histopathology of gastric antrum. The male and female ratio was 2:1. Majority of the patients were either 40 years of age or less, mean age being 40.52 [sd +/- 13.22]. The chief symptoms were pain epigastrium [46%] and upper abdominal discomfort [27%]. Helicobacter pylori gastritis was found in 51% of cases. We conclude that Helicobacter pylori infection is quite common in dyspeptic patients apparently having normal endoscopic gastric mucosal findings. Eradication therapy should be instituted in positive cases to avoid its long-term complications

Anti vascular endothelial growth factor [bevacizumab] in central retinal vein occlusion: an interventional case series

Vascular endothelial growth factor plays major role in ocular angiogenesis and retinal edema production and is a step forward in the management of ocular neovascularization and retinal edematous pathologies. To determine the efficacy and safety of intra-vitreal Avastin [Bevacizumab] in cases having central retinal vein occlusion. A prospective interventional study. This study was done at Said Anwar Medical Centre, Dabgari Gardens, Peshawar from June, 2007 to September, 2009. All patients with central retinal occlusion occurring in the past 3 months and seen between the study period were included in the study. Diagnosis of central retinal vein occlusion was made clinically by slit lamp biomicroscopy with 78D examination Patients who had received any treatment for and eyes which already had developed Anterior Segment Neovascularization, Neovascularization elsewhere or Neovascularization on disc at presentation were excluded. Dose of 0.05 ml [1.25mg] of Avastin [Bevacizumab] was used as intra vitreal injection every month for 3 months in cases that presented within a month of occlusion and less injections were given in dose presenting later. Follow-up was done at 30th, 60[th], 90[th] and 120[th] day after the onset of disease. Visual outcome was defined as Snellen's or LogMar Best Corrected Visual Acuity at final follow up, of 120[th] day, compared to the visual acuity at presentation. Data were analyzed by SPSS version 17. Total of 17 eyes of 17 patients were included in this study. Eleven [64.7%] patients were males while 6 [35.3%] were females. Total of 40 intra-vitreal injections of Avastin were given to patients with a mean of 2.35 injections per eye. Good visual outcome was achieved in 10 [58.8%]] eyes, while 7[41.2%] had stable visual outcome. Mean initial Best Corrected Visual Acuity [LogMar] in all 17 eyes was 1.79 [SD +/- 0.87] which significantly improved to a mean of 1.18 [SD+0.77] at final follow up. Mean improvement in Best Corrected Visual Acuity [LogMar] after paired sample test in all patients at final follow up on day 120 was 0.61[SD+0.84]. Retinal hemorrhages and macular edema decreased clinically on examination on consecutive follow up visits. No eye developed neovascularization elsewhere, neovascularization on the disc, neovascularization, retinal tears, retinal.detachment, lens trauma, endophthalmitis or anterior chamber activity. Bevacizumab [Avastin] is an effective and safe treatment option for central retinal vein occlusion affected eyes and resulted in improvement in visual acuity. It reduced macular edema and prevented ocular neovascularization at least for short term

Comparison of serum lipid profile in ishaemic and haemorrhagic stroke

To compare serum lipid profile between patients of ischaemic and haemorrhagic strokes. Cross sectional, comparative study. Military Hospital, Rawalpindi, from August 2004 to February 2005. Patients with diagnosis of stroke comprising 100 consecutive patients each of ischaemic and haemorrhagic strokes were included in the study while patients on lipid lowering therapy were excluded from study. To determine the subtype of stroke, clinical examination followed by CT scan of brain was done. A serum sample after 8 hours of overnight fasting was taken on the next day of admission for both groups of patients. Total serum cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol and HDL-cholesterol was determined, using enzymatic colorimetric method. Statistical analysis was done by comparison of lipid profile in two subgroups, using proportion test for any significant difference. The mean age at presentation of patients with stroke was 64.2 +/- 12 years with a male to female ratio of 3.6:1. In 100 ischaemic stroke patients, raised serum total cholesterol was seen in 42, triglyceride in 04, LDL-cholesterol in 05 and VLDL-cholesterol in 07 patients. Serum HDL- cholesterol was below the normal reference in 31 cases. On the other hand, serum total cholesterol and triglycerides was raised in 05 patients each, LDL-cholesterol in 09 and VLDL-cholesterol in 03 patients of haemorrhagic stroke. Serum HDL-cholesterol was below normal in 04 patients of haemorrhagic stroke. On comparison, there were significantly greater number of patients with raised srum cholesterol and low HDL-cholesterol in ischaemic stroke than haemorrhagic stroke [p < 0.05]. No statistical significance was found on comparing serum values of ischaemic and haemorrhagic stroke for triglycerides, LDL-cholesterol and VLDL-cholesterol. Ischaemic stroke patients had high serum total cholesterol and lower HDL-cholesterol levels as compared to haemorrhagic stroke. High risk patients of stroke may be screened using srum lipid profile and further studies are suggested to evaluate the effect of lipid lowering therapy in terms of morbidity and mortality in ischaemic stroke patients

Evaluation of AST/ALT ratio as a marker of liver fibrosis and cirrhosis in patients with chronic hepatitis C

To assess the relation between serum AST/ALT ratio [AAR] and hepatic fibrosis and cirrhosis associated with chronic hepatitis C. A cross sectional study. The study was conducted in the department of medicine Military Hospital Rawalpindi from Sep 2004 - Feb 2005. Fifty diagnosed patients of chronic hepatitis C were selected whose liver biopsy was performed as a workup plan fro treatment. Serum AST/ALT ratio [AAR] was determined and degree of liver fibrosis noted on histopathology, using Knodell scoring system. ANOVA was applied to study the difference in AAR in different stages of liver fibrosis. The mean AAR was found to be higher with each increasing stage of liver fibrosis. The mean AAR in cirrhotics [1.34] was significantly higher compared to noncirrhotics [0.77], p<0.001. AAR >/= 1 had 100% sensitivity and negative predictive value in distinguishing cirrhotic from non-cirrhotic patients with 87% specificity and 45% positive predictive value. There is only a modest relation between AAR and early hepatic fibrosis [stages 1-3] in patients with chronic hepatitis C, while AAR is significantly higher in patients with advanced fibrosis/ cirrhosis