Association of Adverse Effects of Red Meat Consumption with Liver Cirrhosis

Objective: To determine the association of adverse outcomes in term of mortality in patients with cirrhosis and red meat consumption. Study Design: Cross-sectional Place and Duration: Medicine Department of Liaquat University Medical Hospital Jamshoro and Civil Hospital Khairpur Mir's for six months duration from December 2019 to November 2020. Methodology: Total 120 patients of both genders with chronic liver disease were enrolled in this study. Patients were categorized in to two groups. Group A (red meat consumption >60 gm/day) and group B (red meat consumption <60gm/day). Outcomes in term of mortality between both groups were examined. All the data was analyzed by SPSS 27.0. Results: There were 36 (60%) males and 24 (40%) were females with mean age 48.14±7.58 years in group A while in group B 39 (65%) and 21 (35%) patients were males and females with mean age 49.08±8.33 years. Cirrhotic patients with red meat consumption >60 gm/day had high mortality rate as compared to patients with red meat consumption <60 gm/day (10% Vs 3.33%) with p-value 0.0001. Conclusion: A significant association of adverse outcomes was found in cirrhotic patients and red meat consumption. Keywords: Chronic Liver Disease, Red Meat Consumption, Mortality

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Association of Adverse Outcomes in Patients with Cirrhosis Presented with COVID-19

10.53350/pjmhs211551134 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1134-1135

Author(s):

M. A. Chhutto ◽

A. H. Mugheri ◽

A. H. Phulpoto ◽

I. A. Ansari ◽

A. Shaikh ◽

...

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Adverse Outcomes ◽

Chronic Liver ◽

P Value ◽

College Hospital ◽

Medical College ◽

Group A ◽

Group B ◽

Disease Study

Objective: To determine the association of adverse outcomes in term of mortality in patients with cirrhosis presented with coronavirus disease. Study Design: Retrospective/observational study Place and Duration of Study: Department of Medicine, Chandka Medical College Hospital, Larkana from 1st March 2019 to 31st December 2020. Methodology: Two hundred and twenty covid-19 patients of both genders with or without chronic liver disease were enrolled in this study. Patients were categorized in to two groups. Group A (with cirrhosis 60 patients) and group B (without cirrhosis 60 patients). Outcomes in term of mortality between both groups were examined. Results: There were 38 (63.33%) males and 22 (36.67%) were females with mean age 46.14±8.44 years in group A while in group B, 40 (66.67%) and 20 (33.33%) patients were males and females with mean age 45.26±9.34 years. Patients with cirrhosis had high mortality rate as compared to patients without cirrhosis (33.33% Vs 13.33%) with p-value 0.0001. Conclusion: A significant association of adverse outcomes was found in cirrhotic patients with coronavirus disease. Keywords: Chronic Liver Disease, Corvid-19, Mortality

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Comparison of Adverse Outcomes in Cirrhotic and Non-Cirrhotic Patients with Covid-19 Disease

10.53350/pjmhs211572289 ◽

2021 ◽

Vol 15 (7) ◽

pp. 2289-2291

Author(s):

Jahangir Anjum ◽

Talal Safdar ◽

Muhammad Imran ◽

Muazzam Fuaad ◽

Waheed Iqbal ◽

...

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Teaching Hospital ◽

Adverse Outcomes ◽

Chronic Liver ◽

P Value ◽

Group I ◽

Cirrhotic Patients ◽

Group Ii ◽

Disease Study

Objective: The aim of this study is to determine the comparison of adverse outcomes in cirrhotic and non-cirrhotic patients presented with coronavirus disease. Study Design: Place and Duration: The department of Medicine of Divisional Headquarters Teaching Hospital Mirpur Azad Kashmir and Mohiuddin Teaching Hospital, Mirpur AJK for six months during the period from October 2020 to March 2021. Methodology: Total 80covid-19 patients of both genders with or without chronic liver disease were enrolled in this study. Patients were aged between 20-55 years. Patients were divided in to two groups. Group I (with cirrhosis 40 patients) and group II (without cirrhosis 40 patients). Outcomes in term of mortality between both groups were examined. All the data was analyzed by SPSS 26.0 version. Results: There were 24 (60%) males and 16 (40%) were females with mean age 44.19±7.65 years in group I while in group II 27 (67.5%) and 13 (32.5%) patients were males and females with mean age 43.62±5.34 years. We found that mortality rate among patients of group I (cirrhotic) had high mortality rate13 (32.5%) as compared to patients without cirrhosis 5 (12.5%) in group II with p-value 0.0003. Conclusion: We concluded in this that frequency of adverse outcomes was significantly high among cirrhotic patients with coronavirus disease as compared to non-cirrhotic patients. Keywords: Corvid-19, Mortality, Chronic Liver Disease

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Role of Rifaximin for the Treatment of Hepatic Encephalopathy in Chronic Liver Disease

BIRDEM Medical Journal ◽

10.3329/birdem.v7i3.33781 ◽

2017 ◽

Vol 7 (3) ◽

pp. 205-211

Author(s):

Ranjit Kumar Paul ◽

Indrajit Kumar Datta ◽

Habib Ahmed ◽

Mohammad Reazul Karim ◽

Md Nazmul Haque ◽

...

Keyword(s):

Liver Disease ◽

Hepatic Encephalopathy ◽

Hospital Stay ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Controlled Study ◽

End Of Treatment ◽

Group A ◽

Group B ◽

Ctp Score

Background: Hepatic encephalopathy (HE) is a common problem in patients with chronic liver disease (CLD) and is characterized by diminished mentation and neuromuscular abnormalities. Rifaximin has been reported to be effective for the treatment of hepatic encephalopathy (HE) in Europe and other countries. It is unknown whether rifaximin is effective for the treatment of hepatic encephalopathy in Bangladeshi patients.Methods: A prospective, randomized, single blind, placebo controlled study was conducted to evaluate the efficacy of rifaximin among patients with cirrhosis of liver with hepatic encephalopathy. A total sixty patients of HE fulfilling inclusion criteria were randomly enrolled among those admitted under Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD) department of BIRDEM General Hospital during August 2012 to April 2013. Patients were divided into two groups: group A (receiving Tab. rifaximin with lactulose), the total number of patients were 31(51.7%) and group B (receiving placebo with lactulose), it was 29(48.3%). Enrolled patients were followed up for 10 days or up to discharge from the hospital or death. At enrollment and at the end of treatment, gradation of HE and estimation of portosystemic encephalopathy (PSE) index was done.Results: In this study between two groups, mean age difference (p=0.404), gender difference (p=0.668) and CLD duration difference (p=0.555) were not statistically significant between two groups. At enrollment, prognostic scores e.g. Child-Turcotte-Pugh (CTP) score (p=0.489) and PSE index (p=0.934) were not significantly different between two groups. At the end of treatment, group A patients showed significantly lower HE grade (P=0.045) and PSE index (P<0.05) than group B. CTP score (p=0.552) was also lower in rifaximin treated group than placebo group but no significant difference was observed. The mean duration of hospital stay was significantly lower in group A than group B (p<0.05).Conclusions: Hepatic encephalopathy patients treated with rifaximin plus lactulose have better outcome and less hospital stay than those treated with placebo plus lactulose.Birdem Med J 2017; 7(3): 205-211

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Lusutrombopag is effective and safe in patients with chronic liver disease and severe thrombocytopenia: a multicenter retrospective study

BMC Gastroenterology ◽

10.1186/s12876-020-01573-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hiroaki Nomoto ◽

Naoki Morimoto ◽

Kouichi Miura ◽

Shunji Watanabe ◽

Yoshinari Takaoka ◽

...

Keyword(s):

Platelet Count ◽

Liver Disease ◽

Chronic Liver Disease ◽

Platelet Transfusion ◽

Chronic Liver ◽

Severe Thrombocytopenia ◽

Invasive Procedures ◽

Significance Level ◽

Group A ◽

Group B

Abstract Background Chronic liver disease (CLD) is often complicated by severe thrombocytopenia (platelet count < 50,000/µL). Platelet transfusion has been a gold standard for increasing the platelet count to prevent hemorrhagic events in such patients. Lusutrombopag, a thrombopoietin receptor agonist, can increase the platelet count in such patients when invasive procedures are scheduled. Former studies on lusutrombopag included patients with a platelet count of > 50,000/µL at baseline: the proportions of patients who did not require platelet transfusion were 84–96%, which might be overestimated. Methods The efficacy and safety of lusutrombopag were retrospectively investigated in CLD patients with platelet count of < 50,000/µL, a criterion for platelet transfusion, in real-world settings. We examined the proportion of patients who did not require platelet transfusion in 31 CLD patients, which exceeded a minimum required sample size (21 patients) calculated by 80% power at a significance level of 5%. Lusutrombopag, 3 mg once daily, was administered 8–18 days before scheduled invasive procedures. Results Among 31 patients who received lusutrombopag, 23 patients (74.2%) patients showed a platelet count of ≥ 50,000/µL (Group A) and did not require platelet transfusion. The remaining 8 patients (25.8%) did not reached platelet ≥ 50,000/µL (Group B). The means of platelet increase were 38,000/µL and 12,000/µL in groups A and B, respectively. A low platelet count at baseline was a characteristic of patients in group B. Among 13 patients who repeatedly used lusutrombopag, lusutrombopag significantly increased the platelet count as the initial treatment. When all repeated uses of lusutrombopag were counted among these 13 patients, platelet transfusion was not required in 82.1% (23/28) of treatments. Although one patient showed portal thrombosis after lusutrombopag treatment, the thrombosis was disappeared by anticoagulant treatment for 35 days. The degree of platelet increase with lusutrombopag was larger than that in their previous platelet transfusion. Conclusions The proportion of patients who did not require platelet transfusion was 74.2%, which is smaller than that in former studies which included CLD patients with a platelet count of > 50,000/µL. However, lusutrombopag is effective and safe for CLD patients with a platelet count of < 50,000/µL.

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A Study of Hypoalbuminaemia in Chronic Liver Disease and its Correlation with Development of Esophageal Varices

Bangladesh Journal of Medicine ◽

10.3329/bjmed.v22i1.13595 ◽

2013 ◽

Vol 22 (1) ◽

pp. 17-20

Author(s):

SF Hossain ◽

QT Islam ◽

MR Siddiqui ◽

A Hossain ◽

N Jahan ◽

...

Keyword(s):

Liver Disease ◽

Serum Albumin ◽

Chronic Liver Disease ◽

Esophageal Varices ◽

Predictive Value ◽

Chronic Liver ◽

Full Blood Count ◽

Group A ◽

Pugh Class ◽

Group B

Background: The aim and objective of this study was to evaluate relationship of serum albumin and esophageal varices in chronic liver disease (CLD) admitted in the medicine unit and gastroenterology department of Dhaka Medical College Hospital. Method: In this cross-sectional study, a total number of 100 randomly selected, clinically diagnosed patients of chronic liver disease were studied from June 2010 to November 2010 (6 months). All patients were assessed as per Child-Pugh class and had full blood count, HBsAg, Anti-HCV antibodies by ELISA, abdominal ultrasound and Endoscopy of upper gastrointestinal tract. Patients were divided into Group A (serum albumin <3.5 gm%) and Group B (3.55). Result: Seventy-three male (73%) and twenty seven female patients (27%)] with age range of 16 to 75 years were evaluated. Out of 100 patients 24% were in between 46-55 years age group. 63% patient fall in child Pugh class A group, 32% fall in child Pugh class B & 5% fall in child Pugh class C. Mean Serum albumin was 3.8 gm%, (range 2.4-4.9). Esophageal varices (EV) were present in 32 patients (32%) and absent in 68 patients (68%). Group A had 29 patients (29% of the total) with 18 patients (62.06%) having EV. Group B had 71 patients (71% of the total) with 14 patients (19.71%) having EV. Sensitivity of hypoalbuminaemia as a marker of EV was 56% and specificity 83.8%, positive predictive value 62.06% and negative predictive value 80.2% and Odds ratio was 6.6. P value is <0.001. Conclusion: In Group A that is hypoalbuminaemia (<3.5 gm%), the incidence of Esophageal varices was more than Group B that is albumin level (>3.5gm%). Hypoalbuminemia is a good surrogate marker for the presence of esophageal varices in CLD. DOI: http://dx.doi.org/10.3329/bjmed.v22i1.13595 Bangladesh J Medicine 2011; 22: 17-20

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Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease?

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.1.4796 ◽

2021 ◽

Vol 38 (1) ◽

Author(s):

Faiza Sadaqat Ali ◽

Nimrah Bader ◽

Bader Faiyaz Zuberi ◽

Tazeen Rasheed

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Predictive Value ◽

Operating Characteristic ◽

Liver Stiffness ◽

Chronic Liver ◽

Liver Stiffness Measurement ◽

Stiffness Measurement ◽

Group A ◽

Group B

Objectives: This study aimed to validate Baveno-VI recommendations for variceal screening in cACLD in our region and proposed our own cutoff values. Methods: Prospective cross-sectional study was conducted on cACLD patients from August 2020 till April 2021. Patients segregated into Group-A, having Liver stiffness measurement (LSM) of ≥ 20 kPa and platelet of ≤ 150 × 109 cells/L; and Group-B having LSM of < 20 kPa and PLT of > 150 × 109 cells/L. Gastroscopic findings were segregated into three categories, VNT, Varices Not Needing Treatment (VNNT) and No Varix (NV). ROC plots were generated for LSM and Platelet for VNT for sensitivity, specificity, Negative and Positive Predictive Values were calculated. Results: A total of 134 patients of cACLD were included. Group-A had 72 (53.7%) patients and Group-B had 62 (46.3%) patients. Group-A had 6 (8.3%) NV; 18 (25.0%) VNNT and 48 (66.7%) VNT. Group-B had 26 (41.9%) NV, 24 (38.7%) VNNT and 12 (19.4%) VNT. The sensitivity of 66.7%, specificity of 80.6% and NPV of 67.56% was obtained. Thus 19.4% VNT were missed on following Baveno VI recommendations. ROC in our study suggested cutoff value of 11.5 kPa with sensitivity of 100% and 1-sepcifity pf 78% (AUROC = 0.865; p < .001) of LSM below which screening gastroscopy could be avoided. The positive and negative predicted values for 84.85% and 100% respectively. Cut off value of platelet count for VNNT came out to be ≥ 97.5 × 109 cells/L with AUROC 0.891 (p < .001), having sensitivity of 100 % and 1-specificity of 83.3%. Conclusions: Substantial number of VNT in cACLD patients are missed by following Baveno-VI recommendations and these needs to be revised on regional basis. List If Abbreviations: AASLD: American Association for Study of Liver Diseases (AASLD), AUROC: Area Under Receiver Operating Characteristic, cACLD: Compensated Advance Chronic Liver Disease (cACLD), CTP: Child-Turcotte-Pugh, DCLD: Decompensated Chronic Liver Disease (DCLD), EV: Esophageal Varices, KPa: Kilo Pascal, LSM: Liver stiffness measurement (LSM), NPV: Negative Predictive Value, NV: No Varix (NV)., PPV: Positive Predictive Value, ROC: Receiver Operating Characteristic, VNNT: Varices Not Needing Treatment (VNNT) and VNT: Varices Needing Treatment (VNT). How to cite this:Ali FS, Bader N, Zuberi BF, Rasheed T. Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease? Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4796 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173580 ◽

2017 ◽

Vol 5 (8) ◽

pp. 3654

Author(s):

Rajendra Kumar Verma ◽

Richa Giri ◽

Mayuri Agarwal ◽

Vaibhav Srivastava

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Spontaneous Bacterial Peritonitis ◽

Tertiary Hospital ◽

Chronic Liver ◽

Albumin Concentration ◽

Bacterial Peritonitis ◽

Presenting Symptoms ◽

Group A ◽

Group B

Background: About half the patients with cirrhosis develop ascites during 10 years of observation. The present study was designed to study the relation between spontaneous bacterial peritonitis and serum ascites albumin gradient in chronic liver disease patients.Methods: This prospective observational study was done in 55 patients with chronic liver disease attending IPD of tertiary hospital. Based on investigation findings, patients were divided into two groups: Group A-Patients with sterile cirrhotic ascites, Group B- Patients with spontaneous bacterial peritonitis. Detailed history, examination and relevant investigation were done. Data was collected, recorded and statistical calculation was done using in Microsoft excel 2007.Results: Most common presenting symptoms of SBP patients were increasing ascites refractory to treatment (90%), followed by peripheral edema (80%). Jaundice and hepatic encephalopathy was found in 75% and 65% respectively. Serum and ascites albumin levels were lower in Group B (2.54±0.33 and 0.43±0.23 g/dl respectively) as compared to Group A (2.85±0.36 and 0.91±0.31 g/dl respectively) and it was statistically significant. The Mean±SD of SAAG for group A and group B was (1.94±0.36) and (2.09±0.47 g/dl) respectively. This difference was statistically not significant.Conclusions:Study conclude that the development of spontaneous bacterial peritonitis in chronic liver disease patients with sterile ascites is directly proportional to ascitic fluid albumin and serum albumin concentration whereas occurrence of SBP is not affected by variation in SAAG ratio if it is already higher than 1.1 g/dl.

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Beneficial influence of an indigenous low-iron diet on serum indicators of iron status in patients with chronic liver disease

British Journal Of Nutrition ◽

10.1017/s0007114500000301 ◽

2000 ◽

Vol 83 (3) ◽

pp. 235-239 ◽

Cited By ~ 5

Author(s):

Neelu Tandon ◽

Varsha Thakur ◽

Raj Kumar C. Guptan ◽

Shiv K. Sarin

Keyword(s):

Liver Disease ◽

Hepatitis B ◽

Chronic Liver Disease ◽

Interferon Therapy ◽

Alanine Transaminase ◽

The Body ◽

Chronic Liver ◽

Dietary Regimen ◽

Group A ◽

Group B

The main Fe storage organ in the body is the liver. In patients with chronic liver disease, secondary Fe overload is common. Phlebotomy, often used in the West to reduce Fe overload to improve the efficacy of interferon therapy, is not socially acceptable in India. We assessed the efficacy of a low-Fe diet in reducing serum Fe levels. Nineteen patients with hepatitis B- and C-related chronic liver disease, ten with normal (< 25 μmol/l) baseline serum Fe levels (group A) and nine with high (> 25 μmol/l) serum Fe levels (group B) were included. All the subjects were advised to eat a low-Fe diet. The daily Fe intake was reduced approximately 50 % by consumption of the rice-based diet. Haemoglobin, serum Fe, transferrin saturation index (TSI), ferritin and alanine transaminase (EC2.6.1.2) levels were studied at 1 and 4 months. Dietary Fe intake and body weight were closely monitored. All patients complied with the dietary regimen and at 4 months significant (P< 0·001) reductions from baseline were seen in serum Fe (20 (SD 3)V. 12 (sd 4) μmol/l group A; 30 (sd 3)v. 19 (sd 7) μmol/l group B) and TSI (38 (sd 8)v. 23 (sd 9) % group A; 53 (sd 15)v. 34 (sd 13) %, group B) in both the groups, albeit earlier in group B subjects. Serum ferritin levels, however, reduced only in group A (112 (sd 62)v. 43 (sd 25) ng/ml,P< 0·05) and not in group B. Non-significant reductions in haemoglobin levels were seen in both groups. Alanine transaminase levels reduced significantly (P< 0·05) in both the groups (95 (sd 49)v. 44 (sd 25) IU/l, group A; 82 (sd 16)v. 51 (sd 14) IU/l group B). Thus, a low-Fe diet results in significant reductions in serum Fe and TSI levels, irrespective of baseline Fe levels. This diet should be evaluated to improve the efficacy of interferon therapy in patients with hepatitis B- and C-related chronic liver disease.

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Thickening of Gallbladder Wall in Chronic Liver Disease - A Marker for Esophageal Varices

Ibrahim Medical College Journal ◽

10.3329/imcj.v6i1.14713 ◽

2013 ◽

Vol 6 (1) ◽

pp. 18-20

Author(s):

Shamsi Ara Begum ◽

Arif Akbar Saibal ◽

Kanta Das ◽

Sharmistha Dey ◽

Akhtar Uddin Ahmed ◽

...

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Esophageal Varices ◽

Gallbladder Wall ◽

Chronic Liver ◽

Wall Thickening ◽

Oesophageal Varices ◽

Group A ◽

The Mean ◽

Group B

This study was done to find out the relationship between gallbladder wall thickening and esophageal varices in chronic liver disease (CLD) patients. A total of 61 CLD patients were included and divided into two groups. Group A included 13 CLD patients with no oesophageal varices and Group B composed of 48 CLD patients with esophageal varices. Mean gallbladder wall thickness (GBWT) of Group B was 5.6±0.2mm compared to 2.7±0.1mm of Group A. The mean differences of GBWT were statistically significant between group A and group B (P<0.05). The mean GBWT was significantly (p<0.05) higher in CLD patients with grade III and IV varices (6.1±.8 mm) compared to grade I and II (3.9±0.7 mm). The result suggests that GBWT may be considered as an important marker for the presence of esophageal varices in CLD patients. DOI: http://dx.doi.org/10.3329/imcj.v6i1.14713 Ibrahim Med. Coll. J. 2012; 6(1): 18-20

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Hepatitis C virus infection and chronic liver disease in children with leukemia in long-term remission

Blood ◽

10.1182/blood.v78.6.1619.1619 ◽

1991 ◽

Vol 78 (6) ◽

pp. 1619-1622 ◽

Cited By ~ 44

Author(s):

A Locasciulli ◽

G Gornati ◽

A Tagger ◽

ML Ribero ◽

D Cavalletto ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Enzyme Linked Immunosorbent Assay ◽

Positive Group ◽

Group A ◽

Group B

Abstract Antibody to the recently identified hepatitis C virus (HCV) was investigated in sera of 50 leukemic children who had chronic liver disease (CLD), observed for 1 to 12.6 years after therapy withdrawal. All patients were tested for anti-HCV at regular intervals: Ortho- enzyme-linked immunosorbent assay (ELISA) test was performed in all cases. Reactive sera were also tested by recombinant immunoblotting assay to define the specificity of the results obtained by ELISA. Twelve cases (24%) were persistently positive (group A), 11 (22%) were transiently anti-HCV+ positive (group B), and 27 (54%) were negative. Mean SGPT peak during follow-up was significantly higher in group A (P = .014, A v B and P less than .00001, A v C). SGPT normalized off- therapy in 1 of 12 cases (group A), 10 of 11 (group B), and 19 of 27 (group C) (P = .0004, A v B and P = .012, A v C). Accordingly, liver histology, available in 37 patients, showed signs of chronic hepatitis in all patients in group A while most patients in group B and C had less severe liver lesions. These results indicate that HCV plays a significant role in the etiology of chronic hepatitis in leukemic patients and that persistent anti-HCV activity correlates with a more severe CLD, which could jeopardize the final prognosis of children cured of leukemia.

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