The Gamma-glutamyl Transpeptidase to Platelet Ratio (GPR) Predict Significant Liver Fibrosis and Cirrhosis in Chronic Egyptian HCV Patients

Non- invasive parameters of liver fibrosis are being widely incorporated and adopted in clinical practice, of them, 2 ratios APRI and FIB-4 were proposed and applied. The gamma-glutamyl transferase -to platelet ratio (GPR) was developed and investigated as available test that is useful in predicting liver fibrosis stages in chronic HBV patients. We aimed to estimate the diagnostic performance of GPR compared to APRI in assessing different fibrosis stages estimated by ultrasound based Transient Elastography in chronic HCV Egyptian patients

Experiencia con Ecocardiograma de estrés dipiridamol y Reserva coronaria no invasiva: Comunicación preliminar / Dipyridamol Stress Echocardiography and Non-invasive Coronary Reserve: Preliminary report

Antecedentes: El Ecocardiograma de Estrés (EE) es una técnica ampliamente utilizada en el estudio de pacientes con Enfermedad Coronaria conocida o sospechada Recientemente se ha preconizado efectuar el test vasodilatador, método recomendado para evaluar no invasivamente la reserva de flujo coronario (RFC). Objetivos: Mostrar la experiencia preliminar con el EE Dipiridamol, con un seguimiento inicial, así como el estudio de la RFC en la porción distal de la arteria Descendente Anterior (ADA). Métodos: Se analizaron 164 pacientes (101 hombres, edad promedio 65 años) a los que se les efectuó un EE Dipiridamol entre Julio 2011 y Septiembre 2012, con una dosis de 0.84mg/kg en 6 minutos, que incluyó el estudio de RFC. Todos los pacientes completaron la prueba sin efectos secundarios significativos, y en un tiempo menor a 25 minutos. El seguimiento se hizo con miras a la aparición de eventos cardiovasculares mayores (revascularización, infarto al miocardio y muerte cardíaca). Resultados: EE resultó positivo para isquemia en 19 (21 por ciento) pacientes. En 19 (12 por ciento) el EE resultó alterado por motilidad parietal; 29 (15 por ciento) presentaron respuesta anormal en la RFC, con una coincidencia de 12 pacientes (7 por ciento) con ambos tipo de alteración; En 142 (88 por ciento) pacientes se logró medir la RFC en ADA. En 151 pacientes se obtuvo datos confiables del seguimiento, que fue en promedio 10 meses (6 a 18); entre estos, 10 pacientes tuvieron alguna revascularización. No hubo infartos ni fallecidos por causa cardio-vascular. Dado el corto período de seguimiento y baja incidencia de eventos, no se pudo establecer el valor predictivo del resultado de la prueba en esta muestra. Conclusiones: Esta experiencia permitió familiarizarse con la técnica del EE con Dipiridamol y estudiar en un alto porcentaje la RFC en la ADA. La técnica es segura y consume muy poco tiempo. Queda pendiente la determinación del valor predictivo de estos resultados en nuestras manos.

Background: Stress Echocardiography is a common technique in the study of patients with known or suspected Coronary artery disease (CAD). Recently the vasodilation test has been recommended for the non invasive study of Coronary Flow Reserve (CFR). Aim: to report our preliminary experience with Di-pyridamol Stress Echocardiography (DSE), an initial follow-up, and the study of CFR in the distal portion of the left anterior descending coronary artery (LAD). Methods: 164 consecutive patients (101 men, mean age 65) with suspected or known CAD underwent a high-dose DSE (0.84 mg/kg over 6 min) between July 2011 and September 2012. The test included a study of CFR. All patients completed the test within 25 min. Prospective follow-up regarding major adverse cardiovascular events(revascularization, cardiac mortality and infarction) was conducted for a mean of 10 months (range 6-18) Results: DSE was positive for ischemia in 34 (21 percent) patients, showed abnormal wall motion in 19 (12 percent), abnormal CFR in 29 (15 percent) , and both abnormalities in12 (7 percent). 142 patients (88 percent) had a normal CFR in the LAD. 151 patients were followed for a mean of 10 months (6 to 18). Ten of these patients required some type of revascularization. There were no myocardial infarctions or cardiac deaths. Due to the short follow up period and the low incidence of events, it was not possible to estimate the predictive value of abnormal CFR. Conclusion: The dipyridamol echo stress test with a study of coronary flow reserve is safe and brief. The predictive value for cardiac events remains to be determined.

The diagnosis of nonalcoholic fatty liver disease / 대한내과학회지

It is important to have a safe and effective diagnostic tool for liver fibrosis. Currently, liver biopsy is the technique of choice for determining hepatic fat deposition and the stage of fibrosis. However, it is an invasive procedure and its use is limited. It may also be subject to sampling error. Because of need for less invasive techniques, new diagnostic modalities are emerging to replace biopsy. In the present review, available new techniques are introduced and the advantages and disadvantages of each one are discussed. Although none of these non-invasive techniques is able to differentiate between steatosis and steatohepatitis and to reveal all features visible using histology, the proposed diagnostic modalities offer a wide range of additional information instead of liver biopsy.

Diagnosis of Helicobacter pylori Infection / 한양의대학술지

Patients can be tested for the H. pylori infection via invasive or non-invasive methods. At present, no single test is absolutely relied upon to detect colonization of H. pylori, and a combination of two tests is recommended if feasible. A growing interest in non-invasive tests for the detection of Helicobacter pylori has been observed recently. Although serology for IgG often is chosen in the outpatient setting because of its convenience, it is less accurate than either the urea breath test (UBT) or stool antigen test. In addition, the UBT and stool antigen test can be used to confirm eradication, whereas serology remains positive for months after eradication. The test should be used in the basis of the clinical circumstances, the likelihood ratio of positive and negative tests, the cost-effectiveness of the testing strategy, and the availability of the tests.