Background. Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular fil... more Background. Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular filtration rate (GFR). However, its role in patients with liver cirrhosis has not been extensively verified especially in the detection of early RI. Patients and Methods. Seventy consecutive potential candidates for living donor liver transplantation with serum creatinine (Cr) <1.5 mg/dL were included. CysC, Cr, and estimated GFR [creatinine clearance (CCr), Cockcroft-Gault formula (C-G), MDRD equations with 4 and 6 variables, CKD-EPI-Cr, CKD-EPI-CysC, and CKD-EPI-Cr-CysC] were all correlated to isotopic GFR. Early RI was defined as GFR of 60-89 mL/min/1.73 m 2 . Results. Patients were 25.7% and 74.3% Child-Pugh classes B and C, respectively. GFR was ≥90, 60-89, and 30-59 mL/min/1.73 m 2 in 31.4%, 64.3%, and 4.3% of the patients, respectively. All markers and equations, except C-G, were significantly correlated to GFR with CKD-EPI-Cr-CysC formula having the highest correlation (r = 0.474...
Background &Aim: To evaluate the aspartate aminotransferase (AST) to platelet ratio index (APRI) ... more Background &Aim: To evaluate the aspartate aminotransferase (AST) to platelet ratio index (APRI) as a predictive factor of sustained viral response in chronic hepatitis C naive patients with genotype 4. Patients &Methods: We conduct this prospective study on chronic hepatitis C naïve patients who were evaluated to start therapy with peg interferon a-2a (180 μg per week) and ribavirin (> 75 kg: 1200 mg and < 75 kg: 1000 mg) for 48 weeks and responders were followed for 24 weeks after end of treatment. Odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the relationship between each risk factor and the sustained virological response (SVR). Results: One hundred and twenty patients were followed prospectively. The mean ± SD of age in our subjects was 35.8 ± 12.5 years; weight 76 ± 12.7 kg , AST 63.8±44.7 IU/mL, alanine aminotransferase (ALT) 74.5± 60 IU/mL, creatinine; 0.96±0.26 mg/dl and platelets 202612±88343/mm. The mean hepatitis C virus RNA viral load w...
Background and aim Urotensin II (U-II), a somatostatin-like cyclic peptide, was recently identifi... more Background and aim Urotensin II (U-II), a somatostatin-like cyclic peptide, was recently identified as the most potent human vasoconstrictor peptide. We investigated whether serum U-II could be considered a marker for portal hypertension (PHT) and its complications in patients with hepatitis C virus (HCV)-related cirrhosis. Patients and methods After clinical, ultrasonographic, and endoscopic assessments and exclusion of patients with hypertension or diabetes and cardiac or renal comorbidities, 75 patients with HCV-related cirrhosis were classified into three equal groups. Group A included 25 patients with PHT presenting with bleeding esophageal varices (EV). Group B included 25 patients with PHT with no history of bleeding EV. Group C included 25 patients without PHT or EV. In addition, 25 apparently healthy volunteers were included as controls (group D). All participants were investigated for liver tests, Child–Pugh scoring, and serum U-II. Results Serum U-II was significantly higher in cirrhotic patients with PHT with and without bleeding EV compared with the other groups; also, it correlated with the severity of liver disease (P<0.0001). U-II, at a cutoff value of 2.07 ng/ml or more, could predict the presence of PHT with 98% sensitivity and 100% specificity (P<0.05), whereas at a cutoff value of 2.51 ng/ml or more, it could predict the presence of bleeding EV with 96% sensitivity and 93.3% specificity (P<0.05). Conclusion Serum U-II in HCV-related cirrhosis could be a simple and easy predictor of the presence of PHT and bleeding episodes in patients with EV.
Background.Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular filt... more Background.Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular filtration rate (GFR). However, its role in patients with liver cirrhosis has not been extensively verified especially in the detection of early RI.Patients and Methods.Seventy consecutive potential candidates for living donor liver transplantation with serum creatinine (Cr) <1.5 mg/dL were included. CysC, Cr, and estimated GFR [creatinine clearance (CCr), Cockcroft-Gault formula (C-G), MDRD equations with 4 and 6 variables, CKD-EPI-Cr, CKD-EPI-CysC, and CKD-EPI-Cr-CysC] were all correlated to isotopic GFR. Early RI was defined as GFR of 60–89 mL/min/1.73 m2.Results.Patients were 25.7% and 74.3% Child-Pugh classes B and C, respectively. GFR was ≥90, 60–89, and 30–59 mL/min/1.73 m2in 31.4%, 64.3%, and 4.3% of the patients, respectively. All markers and equations, except C-G, were significantly correlated to GFR with CKD-EPI-Cr-CysC formula having the highest correlation (r= 0.474) and the ...
Background and aim Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infecti... more Background and aim Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. SBP is a common and potentially life-threatening complication in patients with cirrhosis. This prospective study was undertaken to evaluate the usefulness of leukocyte esterase reagent strips and ascitic fluid lactoferrin in the diagnosis of SBP in cirrhotic patients with ascites. Patients and methods A total of 168 patients with cirrhotic ascites were enrolled. Patients with SBP and culture-negative neutrocytic ascites variant were considered positive as SBP. Full history was taken and complete medical examination was performed. All participants were subjected to full laboratory investigations to assess SBP. Paracentesis was performed, and immediately after, fresh ascitic fluid specimen was collected and tested using a dipstick for granulocyte esterase designed for urine analysis. Quantitative measurements of ascitic fluid lactoferrin concentration were determined using a polyclonal antibody-based enzyme-linked immunosorbent assay specific for human lactoferrin. Results The addition of ascitic fluid lactoferrin levels to leukocyte esterase reagent strips yielded statistically significant effects on the diagnostic accuracy compared with each test alone. Thus, the combination of both tests yielded (considering ascitic fluid lactoferrin concentration≥200 ng/ml and/or dipstick test≥2+) sensitivity, specificity, positive predictive value, and negative predictive value of 91.84, 94.96, 88.24, and 96.58%, respectively. Conclusion Combining both ascitic fluid lactoferrin and leukocyte esterase reagent test strips was found to facilitate very rapid identification of patients with SBP. Specifically, these tests can be performed efficiently to speed up the bedside diagnostics of this clinical entity.
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. The lack ... more Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. The lack of efficient and precise HCC biomarkers prevents early detection resulting in a poor prognosis. Recently, mean platelet volume (MPV) and MPV/platelet count (PC) ratio have been proposed as potential markers of HCC. This study was carried out to verify MPV and MPV/PC ratio in diagnosis of HCC in Egyptian patients with chronic hepatitis C related liver cirrhosis. One hundred and fifty chronic hepatitis C (CHC) patients with chronic hepatitis, cirrhosis or HCC were enrolled in the study. The levels of alphe feto protein (AFP), MPV and MPV/PC ratio were determined compared to 50 healthy persons. MPV and MPV/CP ratio were higher in patients with cirrhosis and those with HCC. The cut off level for MPV for detection of HCC was 10.1 fl, with sensitivity of 70% and specificity of 57%. At a cut off level of 0.82, the sensitivity of MPV/CP ratio was 79.6% and specificity was 72.7%. AFP showed sensi...
Background: Pancreatitis is the most common complication following endoscopic retrograde cholangi... more Background: Pancreatitis is the most common complication following endoscopic retrograde cholangiopancreatography (ERCP), which can on occasions be severe and life threatening. Aim: To compare the efficacy of diclofenac, allopurinol 300 mg and allopurinol 600 mg for the prevention of post-ERCP acute pancreatitis. Patients and Methods: 130 patients were scheduled for ERCP either for diagnosis and or treatment of obstructive jaundice. Patients were randomized to receive a single dose of either: 100 mg diclofenac suppository immediately after ERCP (40 patients, 25 males, mean age 51.8±14.6 years), 300 mg oral allopurinol one hour before ERCP (30 patients, 16 males, mean age 53.3±11.5 years), 600 mg oral allopurinol one hour before ERCP (40 patients, 24 males, mean age 47.6±14.3 years) or no prophylaxis (control group) (20 patients, 14 males, mean age 46.9± 14.4 years). Serum amylase and lipase were measured immediately before, 4 and 24 hours after ERCP. Pancreatitis was considered when...
Background. Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular fil... more Background. Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular filtration rate (GFR). However, its role in patients with liver cirrhosis has not been extensively verified especially in the detection of early RI. Patients and Methods. Seventy consecutive potential candidates for living donor liver transplantation with serum creatinine (Cr) <1.5 mg/dL were included. CysC, Cr, and estimated GFR [creatinine clearance (CCr), Cockcroft-Gault formula (C-G), MDRD equations with 4 and 6 variables, CKD-EPI-Cr, CKD-EPI-CysC, and CKD-EPI-Cr-CysC] were all correlated to isotopic GFR. Early RI was defined as GFR of 60-89 mL/min/1.73 m 2 . Results. Patients were 25.7% and 74.3% Child-Pugh classes B and C, respectively. GFR was ≥90, 60-89, and 30-59 mL/min/1.73 m 2 in 31.4%, 64.3%, and 4.3% of the patients, respectively. All markers and equations, except C-G, were significantly correlated to GFR with CKD-EPI-Cr-CysC formula having the highest correlation (r = 0.474...
Background &Aim: To evaluate the aspartate aminotransferase (AST) to platelet ratio index (APRI) ... more Background &Aim: To evaluate the aspartate aminotransferase (AST) to platelet ratio index (APRI) as a predictive factor of sustained viral response in chronic hepatitis C naive patients with genotype 4. Patients &Methods: We conduct this prospective study on chronic hepatitis C naïve patients who were evaluated to start therapy with peg interferon a-2a (180 μg per week) and ribavirin (> 75 kg: 1200 mg and < 75 kg: 1000 mg) for 48 weeks and responders were followed for 24 weeks after end of treatment. Odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the relationship between each risk factor and the sustained virological response (SVR). Results: One hundred and twenty patients were followed prospectively. The mean ± SD of age in our subjects was 35.8 ± 12.5 years; weight 76 ± 12.7 kg , AST 63.8±44.7 IU/mL, alanine aminotransferase (ALT) 74.5± 60 IU/mL, creatinine; 0.96±0.26 mg/dl and platelets 202612±88343/mm. The mean hepatitis C virus RNA viral load w...
Background and aim Urotensin II (U-II), a somatostatin-like cyclic peptide, was recently identifi... more Background and aim Urotensin II (U-II), a somatostatin-like cyclic peptide, was recently identified as the most potent human vasoconstrictor peptide. We investigated whether serum U-II could be considered a marker for portal hypertension (PHT) and its complications in patients with hepatitis C virus (HCV)-related cirrhosis. Patients and methods After clinical, ultrasonographic, and endoscopic assessments and exclusion of patients with hypertension or diabetes and cardiac or renal comorbidities, 75 patients with HCV-related cirrhosis were classified into three equal groups. Group A included 25 patients with PHT presenting with bleeding esophageal varices (EV). Group B included 25 patients with PHT with no history of bleeding EV. Group C included 25 patients without PHT or EV. In addition, 25 apparently healthy volunteers were included as controls (group D). All participants were investigated for liver tests, Child–Pugh scoring, and serum U-II. Results Serum U-II was significantly higher in cirrhotic patients with PHT with and without bleeding EV compared with the other groups; also, it correlated with the severity of liver disease (P<0.0001). U-II, at a cutoff value of 2.07 ng/ml or more, could predict the presence of PHT with 98% sensitivity and 100% specificity (P<0.05), whereas at a cutoff value of 2.51 ng/ml or more, it could predict the presence of bleeding EV with 96% sensitivity and 93.3% specificity (P<0.05). Conclusion Serum U-II in HCV-related cirrhosis could be a simple and easy predictor of the presence of PHT and bleeding episodes in patients with EV.
Background.Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular filt... more Background.Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular filtration rate (GFR). However, its role in patients with liver cirrhosis has not been extensively verified especially in the detection of early RI.Patients and Methods.Seventy consecutive potential candidates for living donor liver transplantation with serum creatinine (Cr) <1.5 mg/dL were included. CysC, Cr, and estimated GFR [creatinine clearance (CCr), Cockcroft-Gault formula (C-G), MDRD equations with 4 and 6 variables, CKD-EPI-Cr, CKD-EPI-CysC, and CKD-EPI-Cr-CysC] were all correlated to isotopic GFR. Early RI was defined as GFR of 60–89 mL/min/1.73 m2.Results.Patients were 25.7% and 74.3% Child-Pugh classes B and C, respectively. GFR was ≥90, 60–89, and 30–59 mL/min/1.73 m2in 31.4%, 64.3%, and 4.3% of the patients, respectively. All markers and equations, except C-G, were significantly correlated to GFR with CKD-EPI-Cr-CysC formula having the highest correlation (r= 0.474) and the ...
Background and aim Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infecti... more Background and aim Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. SBP is a common and potentially life-threatening complication in patients with cirrhosis. This prospective study was undertaken to evaluate the usefulness of leukocyte esterase reagent strips and ascitic fluid lactoferrin in the diagnosis of SBP in cirrhotic patients with ascites. Patients and methods A total of 168 patients with cirrhotic ascites were enrolled. Patients with SBP and culture-negative neutrocytic ascites variant were considered positive as SBP. Full history was taken and complete medical examination was performed. All participants were subjected to full laboratory investigations to assess SBP. Paracentesis was performed, and immediately after, fresh ascitic fluid specimen was collected and tested using a dipstick for granulocyte esterase designed for urine analysis. Quantitative measurements of ascitic fluid lactoferrin concentration were determined using a polyclonal antibody-based enzyme-linked immunosorbent assay specific for human lactoferrin. Results The addition of ascitic fluid lactoferrin levels to leukocyte esterase reagent strips yielded statistically significant effects on the diagnostic accuracy compared with each test alone. Thus, the combination of both tests yielded (considering ascitic fluid lactoferrin concentration≥200 ng/ml and/or dipstick test≥2+) sensitivity, specificity, positive predictive value, and negative predictive value of 91.84, 94.96, 88.24, and 96.58%, respectively. Conclusion Combining both ascitic fluid lactoferrin and leukocyte esterase reagent test strips was found to facilitate very rapid identification of patients with SBP. Specifically, these tests can be performed efficiently to speed up the bedside diagnostics of this clinical entity.
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. The lack ... more Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. The lack of efficient and precise HCC biomarkers prevents early detection resulting in a poor prognosis. Recently, mean platelet volume (MPV) and MPV/platelet count (PC) ratio have been proposed as potential markers of HCC. This study was carried out to verify MPV and MPV/PC ratio in diagnosis of HCC in Egyptian patients with chronic hepatitis C related liver cirrhosis. One hundred and fifty chronic hepatitis C (CHC) patients with chronic hepatitis, cirrhosis or HCC were enrolled in the study. The levels of alphe feto protein (AFP), MPV and MPV/PC ratio were determined compared to 50 healthy persons. MPV and MPV/CP ratio were higher in patients with cirrhosis and those with HCC. The cut off level for MPV for detection of HCC was 10.1 fl, with sensitivity of 70% and specificity of 57%. At a cut off level of 0.82, the sensitivity of MPV/CP ratio was 79.6% and specificity was 72.7%. AFP showed sensi...
Background: Pancreatitis is the most common complication following endoscopic retrograde cholangi... more Background: Pancreatitis is the most common complication following endoscopic retrograde cholangiopancreatography (ERCP), which can on occasions be severe and life threatening. Aim: To compare the efficacy of diclofenac, allopurinol 300 mg and allopurinol 600 mg for the prevention of post-ERCP acute pancreatitis. Patients and Methods: 130 patients were scheduled for ERCP either for diagnosis and or treatment of obstructive jaundice. Patients were randomized to receive a single dose of either: 100 mg diclofenac suppository immediately after ERCP (40 patients, 25 males, mean age 51.8±14.6 years), 300 mg oral allopurinol one hour before ERCP (30 patients, 16 males, mean age 53.3±11.5 years), 600 mg oral allopurinol one hour before ERCP (40 patients, 24 males, mean age 47.6±14.3 years) or no prophylaxis (control group) (20 patients, 14 males, mean age 46.9± 14.4 years). Serum amylase and lipase were measured immediately before, 4 and 24 hours after ERCP. Pancreatitis was considered when...
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