Q-T interval prolongation in cirrhosis: Relationship and severity.

BACKGROUND: Cirrhosis as the final stage of progressive fibrosis of liver can affect other organs such as lungs, kidneys and heart. "Cirrhotic cardiomyopathy" involves the electrophysiological abnormalities such as QT interval prolongation. We assessed correlation between corrected QT interval prolongation and severity of cirrhosis based on Child Classification in each ECG lead. METHODS: In this case-control study, the patients attending the outpatient clinic and inpatient department of internal medicine of Velayat Hospital in Qazvin were enrolled from September 2014 to July 2015. Total samples were 74 patients, half of which were used as controls. Cirrhosis severity was determined as per Child Classification. Both groups had Ca2+, Mg2+, K+ tested and 12- lead ECG was obtained. The QT interval was corrected by two different formulas: (1) QTc=QT/√RR (QTc1); (2) QTc=QT+1.75 (heart rate-60) (QTc2). To analyze the data, the software SPSS Version 16 and Mann-Whitney, Pearson's chisquare test-Kruskal-Wallis, and t-tests were used. RESULTS: The mean of QTc1 and QTc2 was longer in cirrhotics than the control group. There was a significant correlation between Child score and length of QTc1 in leads: III (p=0.032), AVL (p=0.041), V2 (p=0.049), V6 (p=0.015). There were significant differences in length of QTc1 in leads: V3 (p=0.031) and V6 (p=0.021); and QTc2 in lead V3 (p=0.039) between Child Classification. CONCLUSIONS: Cirrhosis can induce QTc interval prolongation. Lead V3 has statistically significant correlation with the severity of cirrhosis based on child classification. We propose that QT interval prolongation be added as a criterion for prioritizing liver transplantation.

To evaluate of the effect of adding licorice to the standard treatment regimen of Helicobacter pylori

ABSTRACT Objective: The aim of this study was to evaluate the effect of licorice in H. pylori eradication in patients suffering from dyspepsia either with peptic ulcer disease (PUD) or non-ulcer dyspepsia (NUD) in comparison to the clarithromycin-based standard triple regimen. Methods: In this randomized controlled clinical trial, 120 patients who had positive rapid urease test were included and assigned to two treatment groups: control group that received a clarithromycin-based triple regimen, and study group that received licorice in addition to the clarithromycin-based regimen for two weeks. H. pylori eradication was assessed six weeks after therapy. Data was analyzed by chi-square and t-test with SPSS 16 software. Results: Mean ages and SD were 38.8 ± 10.9 and 40.1 ± 10.4 for the study and control groups, respectively, statistically similar. Peptic ulcer was found in 30% of both groups. Response to treatment was 83.3% and 62.5% in the study and control groups, respectively. This difference was statistically significant. Conclusion: Addition of licorice to the triple clarithromycin-based regimen increases H. pylori eradication, especially in the presence of peptic ulcer disease.

To evaluate of the effect of adding licorice to the standard treatment regimen of Helicobacter pylori.

OBJECTIVE: The aim of this study was to evaluate the effect of licorice in H. pylori eradication in patients suffering from dyspepsia either with peptic ulcer disease (PUD) or non-ulcer dyspepsia (NUD) in comparison to the clarithromycin-based standard triple regimen. METHODS: In this randomized controlled clinical trial, 120 patients who had positive rapid urease test were included and assigned to two treatment groups: control group that received a clarithromycin-based triple regimen, and study group that received licorice in addition to the clarithromycin-based regimen for two weeks. H. pylori eradication was assessed six weeks after therapy. Data was analyzed by chi-square and t-test with SPSS 16 software. RESULTS: Mean ages and SD were 38.8±10.9 and 40.1±10.4 for the study and control groups, respectively, statistically similar. Peptic ulcer was found in 30% of both groups. Response to treatment was 83.3% and 62.5% in the study and control groups, respectively. This difference was statistically significant. CONCLUSION: Addition of licorice to the triple clarithromycin-based regimen increases H. pylori eradication, especially in the presence of peptic ulcer disease.

Effects of metformin, pioglitazone, and silymarin treatment on non-alcoholic Fatty liver disease: a randomized controlled pilot study.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the most common reasons of enzyme increase in liver. In About 10 percent of patients with NAFLD, the disease progresses toward Non Alcoholic Steatohepatitis (NASH) and about one third of them may progress toward cirrhosis, liver dysfunction, and even hepatocellular carcinoma. OBJECTIVES: According to high prevalence of NAFLD and the fact that there is no consensus on treatment of this disease, the aim of this study was to assess the effects of metformin, pioglitazone, and silymarin on treatment of NAFLD. PATIENTS AND METHODS: Sixty six patients with NAFLD who were presented in the Endocrinology and Metabolism clinic of Boo'ali Hospital, Qazvin, Iran, were assigned randomly into three groups (n = 22). First group was treated by pioglitazone 15 mg/d, second group by metformin 500 mg/d, and third group by silymarin 140 mg/d. All patients underwent clinical and biochemical evaluations including weight, fasting blood sugar (FBS), lipid profiles, body mass index (BMI), aspartate aminotransferase (AST ), alanine aminotransferase (ALT), and serum insulin levels in pre- and post-intervention after eight-week follow up. RESULTS: Before the treatment there was no significant difference between three groups with respect to average age, BMI and gender, FBS, lipid profile, AST, ALT, serum insulin level, and Homeostasis Model Assessment (HOMA) index for insulin resistance. After the intervention, a significant reduction was observed in average amount of FBS, lipid profile, ALT, AST, serum insulin level and HOMA index in three groups (P < 0.01). The most reduction in average FBS, TG, serum insulin level, and HOMA index was observed in pioglitazone group, the most reduction in average amount of cholesterol was seen in metformin group, and the most decrease in average amount of AST and ALT occurred in silymarin group. CONCLUSIONS: These results suggest that all drugs are beneficial in improving biochemical indices in patients with NAFLD. Changes in AST and ALT in silymarin group were demonstrated more than that in other groups and the average difference between changes was significant between silymarin and metformin groups.

The efficacy of licorice root extract in decreasing transaminase activities in non-alcoholic fatty liver disease: a randomized controlled clinical trial.

This study was performed to investigate the effects of licorice on non-alcoholic fatty liver disease (NAFLD). In this double blind randomized clinical trial, 66 patients were divided into case and control groups. All patients had elevated liver enzymes and had increased liver echogenicity (lipid accumulation) on sonography. The case group was treated with one capsule containing 2 g aqueous licorice root extract per day for 2 months while the control group was treated in the same manner with a placebo. Weight, body mass index (BMI) and liver transaminase levels were measured for each patient before and after the study. In the case group, the mean alanine aminotransferase (ALT) level decreased from 64.09 to 51.27 IU/mL and the aspartate aminotransferase (AST) level decreased from 58.18 to 49.45 IU/mL, which were statistically significant (p < 0.001 and p < 0.001). But in the control group, a drop in the ALT and AST levels was not statistically significant. The BMI difference before and after the study was not statistically significant in both groups. Despite the significant drop in liver enzymes following administration of licorice root extract, it is recommended that further studies that include histological examination are necessary.