Outcome of critically ill cirrhotic patients: an evaluation of the different scoring systems

Several prognostic scoring systems have been designed in an attempt to assess the prognosis of critically ill cirrhotic patients. For this purpose three different prognostic scores [APACHE III score, Child-Pugh score and ICCO score] were studied in intensive care unit, Tropical Medicine and Gastroenterology Department, Assiut University Hospital. A total of 187 cirrhotic patients [149 males, 38 females; age range 15-82 year] were prospectively enrolled in this study. At the time of admission, 73 cases [39%] had bleeding oesophageal varices and 114 cases [61%] had hepatic encephalopathy. Grading of overall severity of liver cirrhosis according to different prognostic scores were done for all studied patients. In patients with hepatic encephalopathy, APACHE III score had the highest positive predictive value [75%] while ICCO score had the highest specificity [89.3%]. On the other hand in critically ill cirrhotic patients with bleeding oesphageal varices APACHE III and ICCO scores had equal positive predictive value [79%] but ICCO score had the highest specificity [92%]. If specificity is considered as a predictor of mortality, ICCO score was found to be the best predictor of mortality in cirrhotic patients who presented with bleeding oesophageal varices and with hepatic encephalopathy followed by APACHE III score. As regards individual laboratory parameters, serum bilirubin was found to be the best single parameter predicting mortality in cirrhotic patients presenting with bleeding oesophageal varices [specificity 90% and sensitivity 89. 74%]. On the other hand plasma lactate was found to be the best laboratory parameter predicting mortality in cirrhotic patients presenting with hepatic encephalopathy [83% positive predictive value and 85% specificity ICCO score was the best predictor of mortality in cirrhotic patients with bleeding oesophageal varices and hepatic encephalopathy followed by APACHE III score. Serum bilirubin was the single laboratory parameter predicting mortality in patients presented with bleeding oesophageal varices. Plasma lactate predicting mortality in who those with hepatic encephalopathy

Study of risk factors among acute HBV infected patients.

This study was designed to determine the various risk factors affecting the transmission of acute hepatitis B and to investigate whether the infection is essentially household or community acquired. The study showed that HbsAg-positive individuals were present more in households of HBV acutely infected patients than households of the controls. Also, anti- HBc IgG seropositivity was significantly higher in patients spouses and contacts than controls spouses and contacts. The various risk factors for transmission of HBV were the following in order of frequencies: Shared blades in barber shops, injections, sharing utensils with HbsAg-positive household member, shared machines in barber shops, shared combs or towels with HbsAg-positive household member, dental procedures, operation, sharing room with HbsAg-positive household member, vaccination, stitches, sharing bed, bedding, blades with or kissing of HbsAg-positive household member, neurological examination [pin pricking] and contact with jaundiced patient

Interrelation between gastroesophageal reflux and chronic obstructive pulmonary disease

Eighty patients with symptoms of GERD were included in this study, thirty of them had a diagnosis of bronchial asthma, twenty were suffering from chronic bronchitis and emphysema and thirty without RS. They were subjected to esophagogastroduodenoscopy for diagnosis and grading of GERD, chest roentgenogram posteroanterior view and ventilatory function tests. The percentage of GERD in patients with bronchial asthma and chronic bronchitis [63% and 55%] was higher than those without RS [40%] but the difference was statistically insignificant. However, grade III GERD was significantly higher in those with chronic bronchitis compared with those without respiratory symptoms. Low flat diaphragm and peak expiratory flow rate[PEFR] <50% were more frequently associated with GERD. The relation of smoking to GERD although approached statistical significance in those without RS, it was insignificant in patients with either bronchial asthma or chronic bronchitis. However, smoking was more frequently associated with grade III GERD [five out of seven] in patients with chronic bronchitis

Oxidative stress and [FAS/APO-1] mediated apoptosis in hcv related chronic liver disease

This study included 20 patients with chronic hepatitis, 19 with Child A liver cirrhosis and 30 with Child B and C liver cirrhosis. Ten healthy individuals were included as controls. Soluble Fas [sFas], as a marker for apoptosis, was estimated in plasma by ELISA. The degree of oxidant stress was determined by measuring plasma levels of lipid peroxide [LPER], nitric oxide [NO] and the antioxidants, superoxide dismutase [SOD] and total thiols. The study indicated that apoptosis in CLD due to HCV is more or less a stage dependent and is related to the level of soluble Fas, oxygen and nitrogen radical production and antioxidant system. From the practical point of view, it may be suggested that pharmacotherapy based on intervention with control of apoptosis deserves further consideration in this particular type of disease