Serum ferritin as a predictor of 30 days mortality in Patients of decompensated chronic liver disease.

BACKGROUND: Serum ferritin is marker for hepatic neco-inflammation and known 1 year mortality predictor in post-transplant patients. However, data on utility as early mortality predictor in patient of cirrhosis is scarce. We investigated whether ferritin can be used as one month mortality predictor in patients of decompensated cirrhosis. METHODS: The study cohort included 132 patients in whom predictors of mortality were studied. RESULTS: One hundred and thirty-two patients with 77 (58.33%) male with a mean age of 54 (±8.3) years with decompensated cirrhosis were followed for 30 days. enrolled for study. Majority of the patients had hepatitis C (71.4%) with 19 (14.3%) cases of hepatitis B related cirrhosis and 5.3%, 4.5% and 2.3% comprising alcoholic, autoimmune and Wilsons related decompensated cirrhosis respectively. Ninety-one (69.42%) patients were alive at end of study period, with serum ferritin levels were significantly different between the survivors and the non-survivors (p< .001) and showed significant correlation with CTP Score (p <.001) and MELD Score (p <.001). Regarding ferritin level and outcome, 76 (all alive) had ferritin level <200 ng/ml, 26 (13 alive, 13 died) had ferritin level between 200-400 ng/ml and 30 (2 alive, 28 died) had ferritin level >400 ng/ml (p= .001). With increasing ferritin level, CTP class as well as MELD score increased. Patients with raised ferritin levels were more likely to die compared to those with lower ferritin levels (p <.001). CONCLUSIONS: Serum ferritin levels correlate with severity of liver disease and are associated with early mortality in patients of decompensated cirrhosis independent of MELD score.

A case report of pneumo-retro-peritoneum: An unusual presentation of ischio-rectal abscess.

INTRODUCTION: Ano-rectal abscesses are common. They however usually do not present with abdominal symptoms. CT although useful is not routinely carried out. Finding of Pneumo-retro-peritoneum with ischio-rectal abscess is rare. CASE PRESENTATION: We present the case of a diabetic gentleman who presented with abdominal pain and distension and was found to have ischio-rectal abscess on perianal examination. Although initially suspected to have acute abdomen due to perforated viscus, CT scan revealed pneumo-retro-peritoneum which appeared to arise due to the abscess. Patient underwent incision and drainage of the abscess followed by serial debridement. He made a complete recovery. CONCLUSION: Abdominal symptoms are rare in ischio-rectal abscess, but they must be kept in mind. Proper diagnosis may avoid a negative laparotomy.

Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome.

BACKGROUND: Hepatopulmonary syndrome (HPS) is a complication of advanced liver disease. The impact of HPS on survival is not clearly understood. MATERIAL AND METHODS: A prospective study was carried out at Department of Medicine, King Edward Medical University Lahore from June 2011 to May 2012. Patients with cirrhosis of liver were evaluated for presence of HPS with arterial blood gas analysis and saline bubble echocardiography. All patients were followed for 6 months for complications and mortality. Cox regression analysis was done to evaluate role of HPS on patient survival. RESULTS: 110 patients were included in the study. Twenty-nine patients (26%) had HPS. MELD score was significantly higher (p < 0.01) in patients with HPS (18.93 ± 3.51) as compared to that in patients without HPS (13.52 ± 3.3). Twenty two (75.9%) patients of Child class C, 5 (17.2%) patients of Child class B and 2 (6.9%) patients of Child class A had HPS (P 0.03). The clinical variables associated with presence of HPS were spider nevi, digital clubbing, dyspnea, and platypnea. HPS significantly increased mortality during six month follow up period (HR: 2.47, 95% CI: 1.10- 5.55). Child-Pugh and MELD scores were also associated with increased mortality. HPS was no longer associated with mortality when adjustment was done for age, gender, Child-Pugh, and MELD scores (HR: 0.44, 95% CI: 0.14-1.41). Both the Child-Pugh and MELD scores remained significantly associated with mortality in the multivariate survival analysis. CONCLUSIONS: HPS indicates advanced liver disease. HPS does not affect mortality when adjusted for severity of cirrhosis.

Anxiety and depression among medical students: a cross-sectional study.

OBJECTIVE: To determine the prevalence of anxiety and depression among medical students at Nishtar Medical College, Multan. METHODS: A cross-sectional study was carried out at Nishtar Medical College, Multan in 2008. The questionnaire was administered to 815 medical students who had spent more than 6 months in college and had no self reported physical illness. They were present at the time of distribution of the questionnaires and consented. Prevalence of anxiety and depression was assessed using a structured validated questionnaire, the Aga Khan University Anxiety and Depression Scale with a cut-off score of 19. Data Analysis was done using SPSS v. 14. RESULTS: Out of 815 students, 482 completed the questionnaire with a response rate of 59.14%. The mean age of students was 20.66 +/- 1.8 years. A high prevalence of anxiety and depression (43.89%) was found amongst medical students. Prevalence of anxiety and depression among students of first, second, third, fourth and final years was 45.86%, 52.58%, 47.14%, 28.75% and 45.10% respectively. Female students were found to be more depressed than male students (OR = 2.05, 95% CI = 1.42-2.95, p = 0.0001). There was a significant association between the prevalence of anxiety and depression and the respective year of medical college (p = 0.0276). It was seen that age, marital status, locality and total family income did not significantly affect the prevalence of anxiety and depression. CONCLUSIONS: The results showed that medical students constitute a vulnerable group that has a high prevalence of psychiatric morbidity comprising of anxiety and depression.