Determining the Risk of Spontaneous Bacterial Peritonitis due to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites.

OBJECTIVES: The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites. METHODS: This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm3 (cases) and non-SBP with PMN count < 250 neutrophils/mm3 (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0. RESULTS: Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05). CONCLUSIONS: Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users.

Frequency of hepatitis D virus infection in hepatitis B surface antigen-positive liver diseases.

OBJECTIVE: To determine the frequency of HDV among hepatitis B surface antigen (HBsAg)-positive liver disorders. STUDY DESIGN: An observational cross-sectional study. PLACE AND DURATION OF STUDY: Medical Unit I, Chandka Medical College Hospital, Larkana, from July 2003 to June 2008. METHODOLOGY: Adult patients with HBs liver related disorders were evaluated for the presence of delta antibodies using commercially available ELISA kits. Descriptive statistics were used for describing data. Proportions of anti D antibodies between gender and age were compared using chi-square test with significance at p < 0.05. RESULTS: Of the 774 cases, 438 were males (60.4%) and 336 were females (39.6%). The mean age was 36.5 ± 14.39 for males and 34.03 ± 13.16 years for females ranging from 15 to 60 years. Anti-HDV was positive in 183 patients (23.6%).The frequency of HDV was not significantly different between the gender groups (p=0.718). HDV infection was markedly higher in chronic than acute liver disorders. CONCLUSION: The HBV/HDV co-infection is frequent in the studied area. Therefore, practitioners and health care managers should be made aware of the risk of dual infection with HBV and HDV.