Comparison of thrombocytopenia in chronic hepatitis c patients with and without cirrhosis

Background: Thrombocytopenia may be one of the manifestation of chronic hepatitis infection

Objective: To assess thrombocytopenia in patients with chronic hepatitis C with and without cirrhosis

Methodology: Study Design: Cross Sectional study: Place and Duration: Department of Gastroenterology at Sheikh Zayed Hospital Lahore from 1[st] January 2009 to 28[th] February 2010. One hundred known patients of HCV in which 64 male and 36 were females with chronic hepatitis C confirmed HCV [RNA] positive. Among these fifty had chronic hepatitis C with cirrhosis, 50 without cirrhosis and 30 normal HCV negative individuals for comparison. All patients were analyzed for Hemoglobin, total leukocyte count and platelet count and ultrasound findings of with imaging for liver cirrhosis. Data was analyzed in statistical program SPSS version 16.0

Results: The results of this study have shown that there was a significant difference of mean platelets count. Platelets of patients with cirrhosis have mean platelets 88.25 +/- 25.39 with mean age 50.33, mean platelets of patients with chronic hepatitis C without cirrhosis have 142.68 +/- 50.69 with mean age 40.93 and mean platelets of control group was 265.30 +/- 34.55 [P-<.001] with mean age 39.07 years

Conclusion: Our study suggested that chronic hepatitis C is associated with thrombocytopenia. As the disease advances, the platelet count significantly decreases

Aspartate aminotransferase-alanine aminotransferase ratio predicts cirrhosis in chronic hepatitis C patients

Background: Hepatitis C virus infection is on rise in Pakistan

Objective: To evaluate serum aspartate aminotransferase and alanine aminotransferase ratio [AST/ALT ratio] in predicting liver cirrhosis of chronic hepatitis C patients

Patient and Methods: Study Design: Aprospective study. Place and Duration of Study: This study was done in Gasteroenterology department at Sheikh Zayed Hospital Lahore. Duration of study was 6 months from 1[st] January to 30[th] June 2010. Total 80 patients of chronic hepatitis C confirmed by PCR were included in the study. The sera of the patients were tested for AST and ALT. Liver biopsy of each patient was performed. Histological Activity Index [HAI] of the specimens was scored on the basis of Knodell score. AST/ALT ratio was correlated with the histological stage [i.e. degree of fibrosis], and the histological grade [i.e. inflammatory activity]

Results: The mean AST/ALT ratio in 40 cirrhotic patients [1.64 +/- 0.46; p < 0.001]. A ratio = 1 has 96.38% specificity and 93.73% positive predictive value in distinguishing cirrhotic from noncirrhotic patients with 88.26% sensitivity and 94.84% negative predictive value. The ratio correlated positively with histological stage but not with the grade. Two patients out of 17 cirrhotic patients [12%] have no clinical or biochemical features suggestive of chronic liver disease except for an AST/ALT ratio more than one

Conclusion: It is concluded that AST/ALT ratio = 1 is highly specific for the presence of cirrhosis in patients with chronic hepatitis C. This ratio reflects the fibrosis stage in these patients. This ratio may be considered as a marker of fibrosis in patients with chronic hepatitis C

Spontaneous bacterial peritonitis; microbiological analysis of ascitic fluid in patients with complicated liver cirrhosis

Spontaneous bacterial peritonitis is a serious event in patients with liver cirrhosis and associated with significant morbidity and mortality. Most common causative organisms of SBP are E.coli, streptococcus pneumonia and klebsiella. Liver cirrhosis has multifactorial etiology and the most common causes in our country are hepatitis C and hepatitis B. [1] To observe the culture and sensitivity pattern of ascitic fluid in patients with liver cirrhosis. [2] To examine the resistance against various antibiotics. 6 months. Study was conducted in department of Gastroenterology Hepatology in collaboration with department of microbiology of Sheikh Zayed Hospital, Lahore. Sample size; 80 patients of liver cirrhosis with ascites. Sampling technique, Non probability purposive technique was adopted. Sample selection; By Inclusion and Exclusion criteria. Data collection procedure; Eighty patients with liver cirrhosis and ascites diagnosed on the basis of history, examination and ultrasound findings. After detailed history examination and full aseptic measures at least 10 ml of ascitic fluid in 20ml syringe with 16G needle was drawn in blood culture bottle at bed side and was sent to microbiology laboratory for culture and sensitivity and record of resistance and sensitivity against various antibiotics used to treat SBP. Data analysis procedure; Data was analyzed by SPSS version 10.Quantitative variables and were recorded as mean+S.D and qualitative variables, were recorded as frequencies and percentages. Out of 80 patients with suspected SBP 38[47.5%] were culture positive while 42[52.5%] were culture negative. Among these 14[36.84%] showed gram positive growth and 20[52.63%] gram negative growth while 4[10.52%] showed anaerobes. Most of the organisms were resistant to ceftazidim, cefoperazone and augmentin while sensitive to levofloxacin, ceftriaxone, cefotaxime and ciprofloxacin. Highest resistance was against ceoftazidim which was 36[95%] followed by cefoperazone 35[92%]. Spontaneous bacterial peritonitis is devastating complication of liver cirrhosis and ascites and is a leading cause of disability and death in patients with chronic liver disease. Early diagnosis and treatment with proper antibiotics and dosage are necessary for better outcome