Effects of Ramadan fasting on Muslim patients with liver cirrhosis: a comparative study

Background: Patients with liver cirrhosis seem to be at increased risk of complications during fasting. This study aimed to assess the effect of Ramadan fasting on liver functions and portal hemodynamics among patients with liver cirrhosis in comparison with healthy subjects

Materials and Methods: Participants were divided into three groups. Group I: patients with liver cirrhosis who fasted during Ramadan [n = 34], group II: patients with cirrhosis who did not fast [n = 8], and group III: healthy volunteers who fasted [n = 30]. This study was done from May 2017 to July 2017 and the month of Ramadan began on May 27th to June 26th, 2017. Portal hemodynamics were evaluated by portal vein diameter, congestion index [CI], and portal flow velocity. Laboratory investigations were determined before, during, and after Ramadan as an indicator of the changes in the liver functions

Results: There were no dropouts during the study. Among the three groups, portal vein parameters showed statistically non-significant differences. Model for End-Stage Liver Disease [MELD] score and serum albumin levels showed a significant difference when the group I and II compared separately to group III [P = 0.000], while there were no differences between group I and group II [P = 0.6 and 0.57, respectively]. For portal vein CI, there was a significant difference between the patients with cirrhosis [fasting; group I and non-fasting; group II] and healthy subjects [group III] [p = 0.000], while the CI did not change significantly between the groups I and II [p = 0.54]

Conclusions: Patients with cirrhosis showed changes in their liver functions and portal hemodynamics irrespective of their fasting status and these differences were more pronounced in portal vein CI, MELD score, and serum albumin when compared with healthy subjects

Is diffusion weighted imaging adding value in diagnosis of focal hepatic lesions? Experience in 50 patients

Diffusion weighted imaging [DWI] offers molecular information that complements the morphologic information obtained with conventional magnetic resonance imaging [MRI] and can reflect the functions and structures of the body without trauma. To assess the role of DWI as a routine sequence in a MRI study to help in differentiating liver lesions. The study included 50 patients referred to do a MRI study to diagnose and/or to confirm the ultrasonographic or CT findings of focal hepatic lesions. The examination was done on 1.5T superconducting magnet MRI machines; Philips Gyroscan Intera version 12.1.1.2 [Best, The Netherlands] and Siemens Magnetom Avanto [Erlangen, Germany] machine. All studied patients had a focal hepatic lesion either on top of cirrhotic liver or non cirrhotic liver. DWI was found to be helpful with the routine MRI sequences to reach the diagnosis. The final diagnosis was confirmed by histopathological examination or follow up. A cutoff value of ADC for benign lesions was found to be 1.25 x 10[-3] mm[2]/s. DWI should be included as a basic sequence in the routine MRI study of the liver as it helps in diagnosis and so reaching a final diagnosis or at least trying to narrow the list of differential diagnosis

Huge amoebic liver abscess presented with massive right empyema: a case report

Amoebic liver abscess is a complication of amoebiasis that needs early diagnosis and proper treatment before further complications occur. We report a-35 year old female presented by fever and dyspnea due to huge liver abscess complicated by massive right side empyema. The patient was effectively treated by percutaneous drainage for both the right lobe abscess and empyema together with pharmacologic agents

Warm versus cold cardioplegia in CABG

Methods Prospectively collected data concerning all isolated coronary bypass operations from November 2001 to February 2004 at Natural Heart Institute were analyzed to determine the effects of cold blood cardioplegia and warm blood cardioplegia on early outcomes after surgery. Warm blood cardioplegia was used in 200 patients, whereas cold blood cardioplegia was used in 200. The allocation of patients to receive warm blood cardioplegia and cold blood cardioplegia was random in 200 cases and according to surgeon preference in the remainder. Results Perioperative death, myocardial infraction, and death or myocardial infraction were all more common in the cold blood cardioplegia group than in the warm blood cardioplegia group [death 2.5% vs. 1.5%, P = 0.027; myocardial infraction 5.5% vs. 2.5%, P < 0.0001, death or myocardial infraction 7.5% vs. 4.0%, P< 0.0001, Actuarial survival at 36 months was 91% in the warm blood cardioplegia group and 89% in the cold blood cardioplegia group [P = 0.09], whereas freedom from death or myocardial infraction was 85% +/- 1.8% and 83%, respectively [P = 0.16]. Conclusions In 200 patients undergoing isolated coronary artery bypass grafting, warm blood cardioplegia may be associated with better early and late event-free survivals than is cold cardioplegia

Occupational hazards of Liquorice extraction in one of the pharmaceutical industries

Liquorice is one of the plants widely used in medicine for gastrointesinal problems and as a flavoring agent in tobacco and soft drink industries. The main active constituents of liquorice are glycyrrhetic acid and samponin. These two active components have been investigated by many authors and glycyrrhetic acid was suggested to be a hypertensive agent. In our study we tested this hypotethesis in workers occupationally exposed to liquorice during its industrial extraction in one of the pharmaceutical companies in Egypt. Twenty two occupationally exposed workers were clinically examined, 78% had respiratory problems. 73% showed history of nasal and upper respiratory tract irritation, while 36% had hypertension more than 160/95. The mean value of total cholesterol was 144.5 +/- 23.6, LDL 88.7 +/- 17.3, HDL 43.65 +/- 21.4, Gamma-GT 6.8 +/- 2.8, SGOT 9.3 +/- 0.97, SGPT 8.6 +/- 3.6 and serum creatinine 0.89 +/- 0.2 Ammonia levels in the working environment were 35-48 ppm. Our data indicated that liquorice had a hypertensive effects on the exposed group, however these workers had lower levels of serum lipids which requires further study to explore the pharmacological effect of liquorice on humans who had hyperlipidemia