Critical flicker frequency test for diagnosing minimal hepatic encephalopathy in patients with cirrhosis.

BACKGROUND/AIMS: The critical flicker frequency (CFF) and psychometric hepatic encephalopathy score (PHES) are commonly proposed tests for detecting minimal hepatic encephalopathy (MHE); however, no studies have examined their value for detecting MHE in Turkey. MATERIALS AND METHODS: A total of 70 patients with cirrhosis without overt HE, 205 controls for PHES, and 100 controls for the CFF test were included. All the patients underwent the PHES and CFF tests during the same session. Psychometric tests comprising number connection test A and B, digit symbol test, serial dotting test, and line drawing test were used. Tests were considered abnormal when test score was more than mean ± 2 standard deviations in comparison with that of the age- and education-matched controls. MHE was diagnosed when ≥2 PHES test were abnormal, and CFF was <39 Hz. RESULTS: The prevalence of MHE among the 70 patients with cirrhosis, as measured by the CFF and PHES tests, was 41.4% (29) and 30.7% (25), respectively. The mean CFF was significantly lower in patients with cirrhosis having MHE (38.3±1.2 Hz) than in patients with cirrhosis not having MHE (42.6±2.3 Hz; p=0.001) and in controls (44.84 ± 3.7 Hz; p=0.001). With a cutoff value of <39, CFF had a sensitivity of 39%, specificity of 82%, and diagnostic accuracy of 70.6% for detecting MHE. CONCLUSION: The CFF test is also a useful method for detecting MHE in xxx patients with cirrhosis. However, the CFF test should be used as an adjunct to the PHES test because of its low sensitivity for detecting MHE.

Psychopathology, quality of life, and related factors in children with celiac disease.

OBJECTIVE: This study aimed to survey children with celiac disease (CD) for psychiatric disorders, determine the possible factors that predict psychopathology, and analyze health-related quality of life and possible factors that could affect the quality of life. METHODS: In this study, all children completed the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version - Turkish Version (K-SADS-PL-T), as well as the Pediatric Quality of Life Inventory (PedsQL) for the 8-12 age group, and a sentence completion test. A face-to-face interview was performed with the parents of the participants to inform them about the study. RESULTS: This study included 52 children with celiac disease in the age range of 8-12 years, and 40 healthy children. The mean age of the study group was 10.36±0.36 years, and 31 (59%) of them were females. The mean age of the control group was 10.35±0.46 years and 24 (60%) of them were females. The mean subscale scores of the Pediatric Quality of Life Inventory were significantly lower in children with celiac disease when compared to the control group (p<0.05). There was at least one psychiatric disorder in the 26 (50%) children with celiac disease. CONCLUSIONS: This study has shown once more that celiac disease is associated with some psychiatric signs/diagnoses, and that it decreased quality of life. Further studies are needed to determine the factors that could reduce the psychiatric signs. It is apparent that those studies would contribute new approaches to improve diagnosis, treatment, and quality of life.

Usefulness of the Neutrophil-to-lymphocyte Ratio and Platelet Morphologic Parameters in Predicting Hepatic Fibrosis in Chronic Hepatitis C Patients.

BACKGROUND: Chronic hepatitis C (CHC) can progress to fibrosis and cirrhosis. The current gold standard for the diagnosis and staging of hepatic fibrosis is liver biopsy, but liver biopsies have various limitations. We evaluated the neutrophil-to-lymphocyte ratio (NLR) and platelet morphologic parameters to determine fibrosis in CHC patients. METHODS: We retrospectively reviewed the data of 144 patients who were diagnosed with CHC by percutaneous liver biopsy. Patients' fibrosis scores and histological activity indices were calculated according to the Ishak scoring system. RESULTS: Eighty-six patients (60%) were female, and the mean age of the whole group was 53.7 years. The low fibrosis (F1-2) group included 56 patients, the high fibrosis group (F3-6) included 88 patients, and the cirrhosis group (F5-6) included 38 patients. There was no statistically significant difference between low and high fibrosis groups or cirrhotic and noncirrhotic groups in terms of NLR. However, plateletcrit (PCT) was significantly lower in patients with cirrhosis and high fibrosis. CONCLUSIONS: NLR is not associated with histological severity and is not an adequate test to determine either significant fibrosis or cirrhosis. For the first time in the literature, this study showed that PCT was significantly lower in patients with significant fibrosis and that NLR was positively correlated with cholestatic liver enzyme leves.

Analysis of liver function test abnormalities in kidney transplant recipients: 7 year experience.

OBJECTIVE: Immunosuppressive drugs, antimicrobial agents and infectious complications may cause liver function test abnormalities (LFTA) in kidney transplant recipients (KTR). The objectives of this study were to identify the outcome of (LFTA). To identify the risk factors affecting development and severity of hepatotoxicity in KTR. METHODS: We retrospectively evaluated the medical records of KTR. Hepatotoxicity attacks were defined as impairment in liver function tests that was responsive to drug dose reduction or discontinuation, or treatment of specific causes such as infectious complications. RESULTS: One hundred-fifty-six episodes of hepatotoxicity occurred in 107 patients in 281 KTR, with an incidence of 38%. Patients with hepatotoxicity episodes had a high total mortality rate, higher incidence of positive pre-transplant cytomegalovirus (CMV) IgM test, higher creatinine values during the first month post-transplant, underwent additional acute rejection episodes, and received fewer cyclosporin A based ID. Only positive CMV IgM testing was identified as a significant independent risk factor for hepatotoxicity in our multiple analysis. Mycophenolatemofetil (MMF) related hepatotoxicity was the most common cause of drug related LFTA. CONCLUSIONS: Patients with LFTA can have significant complications. Pre-transplant positive CMV IgM tests predispose transplant recipients to the development of LFTA during the post-transplant period. MMF can be a serious hepatotoxic drug.

The diagnostic value of a globulin/platelet model for evaluating liver fibrosis in chronic hepatitis B patients.

BACKGROUND: Liver biopsy, which is considered the best method for evaluating hepatic fibrosis, has important adverse events. Therefore, non-invasive tests have been developed to determine the degree of hepatic fibrosis in patients with chronic hepatitis B. AIM: To verify the usefulness of a new fibrosis index the globulin/platelet model in patients with chronic hepatitis B and to compare it with other noninvasive tests for predicting significant fibrosis. This study was the second to evaluate the globulin/platelet model in HBV patients. METHODS: We retrospectively investigated 228 patients with chronic hepatitis B who performed liver biopsy from 2013 to 2014. The globulin/platelet model, APGA [AST/Platelet/Gamma-glutamyl transpeptidase/Alfa-fetoprotein], FIB4, fibrosis index, cirrhosis discriminate score, and Fibro-quotient were calculated, and the diagnostic accuracies of all of the fibrosis indices were compared between the F0-2 (no-mild fibrosis) and F3-6 (significant fibrosis) groups. RESULTS: All of the noninvasive markers were significantly correlated with the stage of liver fibrosis (p < 0,001). To predict significant fibrosis (F ≥ 3), the area under the curve (95% CI) was found to be greatest for APGA (0.83 [0.74-0.86]), followed by FIB-4 (0.75[0.69-0.80]), the globulin/platelet model (0.74 [0.68-0.79]), fibrosis index (0.72 [0.6-0.78], cirrhosis discriminate score (0.71 [0.64-0.76]) and Fibro-quotient (0.62 [0.55-0.7]). The area under the receiver operating characteristic curves of APGA was significantly higher than that of the other noninvasive fibrosis markers (p < 0.05). CONCLUSIONS: While the APGA index was found to be the most valuable test for the prediction significant fibrosis in patients with chronic hepatitis B, GP model was the thirth valuable test. Therefore, we recommended that APGA could be used instead of the GP model for prediction liver fibrosis.

The diagnostic value of a globulin/platelet model for evaluating liver fibrosis in chronic hepatitis B patients

BACKGROUND: Liver biopsy, which is considered the best method for evaluating hepatic fibrosis, has important adverse events. Therefore, non-invasive tests have been developed to determine the degree of hepatic fibrosis in patients with chronic hepatitis B. AIM: To verify the usefulness of a new fibrosis index the globulin/platelet model in patients with chronic hepatitis B and to compare it with other noninvasive tests for predicting significant fibrosis. This study was the second to evaluate the globulin/platelet model in HBV patients. METHODS: We retrospectively investigated 228 patients with chronic hepatitis B who performed liver biopsy from 2013 to 2014. The globulin/platelet model, APGA [AST/Platelet/Gammaglutamyl transpeptidase/Alfa-fetoprotein], FIB4, fibrosis index, cirrhosis discriminate score, and Fibro-quotient were calculated, and the diagnostic accuracies of all of the fibrosis indices were compared between the F0-2 (no-mild fibrosis) and F3-6 (significant fibrosis) groups. RESULTS: All of the noninvasive markers were significantly correlated with the stage of liver fibrosis (p < 0,001). To predict significant fibrosis (F ≥ 3), the area under the curve (95% CI) was found to be greatest for APGA (0.83 [0.74-0.86]), followed by FIB-4 (0.75[0.69-0.80]), the globulin/platelet model (0.74 [0.68- 0.79]), fibrosis index (0.72 [0.6-0.78], cirrhosis discriminate score (0.71 [0.64-0.76]) and Fibro-quotient (0.62 [0.55-0.7]). The area under the receiver operating characteristic curves of APGA was significantly higher than that of the other noninvasive fibrosis markers (p < 0.05). CONCLUSIONS: While the APGA index was found to be the most valuable test for the prediction significant fibrosis in patients with chronic hepatitis B, GP model was the thirth valuable test. Therefore, we recommended that APGA could be used instead of the GP model for prediction liver fibrosis

Terlipressin-induced ischemic skin necrosis: a rare association.

BACKGROUND: Terlipressin is a synthetic vasopressin analogue that is used in the treatment of bleeding esophageal varices and hepatorenal syndrome in patients with cirrhosis. Serious ischemic adverse events, such as skin necrosis involving the extremities, scrotum, trunk, and abdominal skin, are rarely observed. In the literature to date, 20 cases that developed ischemic skin necrosis due to terlipressin usage have been reported. CASE REPORT: We report a patient with extensive skin necrosis on the infusion site of the right forearm and hand, which developed after the use terlipressin used to treat bleeding oesophageal varices in a 65-year-old man with cirrhosis. CONCLUSIONS: Although rare, ischemic complications of terlipressin do occur.