ABSTRACT
Objectives This study aimed to identify the causes, clinical characteristics, and 28-day in-hospital mortality predictors in patients with acute-on-chronic liver failure (ACLF). Methods A cross-sectional study enrolled sixty-four patients aged 18-70 years with acute-on-chronic liver failure. The study was conducted at the Gastroenterology Department, Lahore General Hospital. The study classified ACLF according to the criteria of the European Association for the Study of the Liver - Chronic Liver Failure (EASL-CLIF). Patients were followed for 28 days for mortality outcomes. The outcomes between Survivor and Non-survivor groups were compared using the Chi-Square/Fisher's Exact Test for categorical variables and the Mann-Whitney U test for continuous variables. Results In this study, age and duration of chronic liver disease were not significantly different between survivors and non-survivors. The etiology of liver disease and ACLF causes had no impact on 28-day mortality. Non-survivors had lower mean arterial pressure, and higher mortality was linked with lower Glasgow Coma Scale scores, upper gastrointestinal bleeding, and Grade IV hepatic encephalopathy. Significant differences in bilirubin, serum creatinine, urea, and C-reactive protein levels were observed at 28 days. Survival rates were highest with single organ failure (35.94%) and decreased with multiple organ failures. The overall survival rate was 51.56%. Predictive validity for mortality was assessed using the Area Under the Curve (AUC), with Child-Turcotte-Pugh (CTP) at 0.679, Model for End-Stage Liver Disease (MELD) at 0.819, and Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) at 0.771. Conclusion This study concludes that in acute-on-chronic liver failure, factors like age, gender, and disease etiology do not significantly predict 28-day mortality. Key mortality indicators include clinical parameters such as lower Glasgow Coma Scale scores, hepatic encephalopathy Grade IV, and laboratory findings like elevated bilirubin and serum creatinine. The MELD score is the most compelling prognostic tool.
ABSTRACT
The objective of this study was to compare the efficacy and safety of intralesional 5-fluorouracil (5-FU) and triamcinolone acetonide (TA) in the treatment of localized vitiligo. the A non-randomized control trial conducted at Sheikh Zayed Hospital, RYK, from January to June 2022 included sixty patients, aged 18-60 years, with stable vitiligo. Patients were divided into two groups: Group A received 5-FU and Group B received TA. The outcome was assessed using the Vitiligo Area Scoring Index (VASI). There were 58.3% male and 41.7% female, with an average age of 33.33±11.24 years. Baseline characteristics between the two treatment groups were comparable. At 12 weeks, treatment responses were classified as excellent (16.6%), good (16.6%), moderate (35%) and poor (31.6%), with no significant intergroup differences (p=0.203). The 5-FU group showed a more significant lesion size reduction (1.28±1.09cm²) than the TA group (0.61±1.21 cm²) (p=0.028). Adverse effects mainly included pain and erythema. Common side effects included pain and erythema. The study concludes that both intralesional 5-FU and TA are effective and safe for treating localized vitiligo, with 5-FU potentially being more efficacious in lesion size reduction and promoting repigmentation.
