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

To confirm the usefulness of aspartate aminotransferase - alanine aminotransferase ratio [AST/ ALT ratio] in predicting cirrhosis in patients with chronic hepatitis C. A prospective non interventional study. Combined Military Hospital, Kharian. Fifty Five patients with chronic hepatitis C were included in the study. Groups included were the patients admitted with sign and symptoms of chronic liver disease due to hepatitis C, blood donors found incidently to be Anti - HCV positive and the persons rejected from embassies duet to Anti-HCV postitive serostatins. 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]. The mean AST/ALT ratio in 17 cirrhotic patients [1.11 +/- 0.18] was higher than in 38 noncirrhotic patients [0.72 +/- 0.23; p < 0.05]. A ratio 1 had 97.36% specificity and 93.75% positive predictive value in distinguishing cirrhotic from noncirrhotic patients with 88.23% sensitivity and 94.87% negative predictive value. The ratio correlated positively with histological stage but not with the grade. Two Patients out of 17 cirrhotic patients [12%] had no clinical or biochemical features suggestive of chronic liver disease except for an AST/ ALT ratio more than one. 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 can be considered as a dependable marker of fibrosis in patients with chronic hepatitis C

Clinical presentation of pancytopenia in children under 15 years of age

The aim of the study was to know the clinical presentation and the most common clinical manifestation of Pancytopenia in children up to 15 years of age.This was a hospital based prospective study carried out in the department of Paediatrics, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from 1st January 2001 to 31st December 2001. 60 patients who fulfilled the inclusion criteria were included in our study. Results; The various clinical presentation were anaemia [87%], fever [50%], petechial haemorrhages [15%], bone pain, hepatospleenomegaly [25%], and bleeding from nose [27%], oral cavity [17%], rectum and urethra [51%]. The most common presentation was progressive pallor followed by fever. the most common clinical presentation is pallor followed by fever and the most common clinical manifestation was anaemia followed by pyrexia, bruises, hepatosplenomegaly and bleeding from mucosal surface