Erectile dysfunction in patients with chronic hepatitis C virus infection

Hepatitis C virus [HCV] infection is a major public health problem worldwide and in Egypt. Several studies have suggested that chronic HCV infection may be associated with erectile dysfunction [ED] in men. The aim of our study was to detect the prevalence of ED among male patients with chronic HCV infection. The study included 150 male patients with chronic HCV infection [124 patients with chronic hepatitis and 26 patients with HCV-associated liver cirrhosis]. The Child-Pugh score was used to assess the severity of cirrhosis. An Arabic validated version of the five-item International Index of Erectile Function [IIEF-5] was used to detect the presence and severity of ED. The patients' age ranged from 20 to 80 years with mean age +/- standard deviation [SD; 50 +/- 17.19] years. The prevalence of ED among patients with chronic HCV infection was found to be 29.3%. The prevalence was significantly higher in cirrhotic as compared to chronic hepatitis patients [p < 0.001] and the average ED score was significantly lower in patients with liver cirrhosis than in those with chronic hepatitis. There was a highly significant relation between the severity of ED and the severity of liver disease. There was a significant negative correlation between serum bilirubin and ED score and a significant positive correlation between serum albumin and ED score in patients with liver cirrhosis. About 30% of patients with chronic HCV infection were found to have ED: so, given the high prevalence of HCV infection in Egypt, chronic HCV infection may be considered in the differential diagnosis of ED. There was a highly significant relation between the severity of ED and the severity of liver disease and the majority of patients with liver cirrhosis proved to be suffering from ED, which may be related to the associated hypoalbuminaemia

Predictors of early re-bleeding and mortality after acute variceal haemorrhage

Oesophageal variceal haemorrhage is a devastating complication of portal hypertension [PHT]. This study was done to determine the risk factors for re-bleeding within 5 days and mortality up to 6 weeks in patients with cirrhosis and acute variceal haemorrhage [AVH]. The study included 100 patients presenting with haematemesis and/or melena due to bleeding varices. All patients were subjected to full clinical assessment, routine laboratory investigations, calculation of the Child-Turcotte-Pugh [CTP] and model for end stage liver disease [MELD] scores, abdominal ultrasound and emergency upper gastrointestinal endoscopy. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding [in the first 5 days] and mortality [up to 6 weeks] after the acute attack. The patients were grouped into three groups: Group I: patients who survived more than 6 weeks following endoscopic management and did not rebleed during this period [75 patients]. Group II: patients who died within 6 weeks of AVH [10 patients]. Group III: patients who rebled or died within 5 days of AVH [15 patients]. The mean MELD score was significantly higher in group II [18.29 +/- 0.66] and group III [18.73 +/- 0.89] as compared to group I [12.8 +/- 2.1] [p = 0.001]. Active bleeding at time of endoscopy was present in 8% of group I, 70% of group II and 53.3% of group III and the difference was statistically significant [p = 0.003], while white nipple sign was present in 10.6% of group I, 90% of group II and 73.3% of group III and the difference was statistically significant [p = 0.05]. In conclusion high MELD score [>18], presence of active bleeding or white nipple sign at time of endoscopy are significant predictors for early rebleeding and mortality after AVH