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[en] Anorexia, nausea, and vomiting are one of the most frequent symptoms in viral hepatitis patients. These may be due to poorly detoxified substances by dysfunctioned hepatocytes or by gastritis, but the pathophysiology is not totally understood. The symptoms interfere with adequate nutrient intake and are managed by metaclopramide, which accelerates gastric emptying. Thus delayed gastric emptying may well be a contributing factor to such symptoms. To determine such a relationship, we measured gastric emptying time in 11 normal subjects, 9 acute (AVH), and 12 chronic B viral hepatitis (CVH) patients. All were males with a mean age of 23 years. An egg was labeled with 0.5 mCi of 99mTc-sulfur colloid, fried, then eaten between 2 slices of bread with 100 cc of water. Anterior and posterior images were taken at 20 minute intervals over a 2 hour period. A geometric mean of activity pertaining to the gastric region was measured, and T1/2 was calculated from the time activity curve. T1/2 for normal the group was 57.8 ± 6.3 minutes while that for the AVH and CVH group was 58.2 ± 8.2 (p=0.40) and 64.1 ± 10.5 (p=0.09), respectively. There was 1 AVH patient and 4 CVH patients with prolonged T1/2. Anorexia and nausea was seen in 71% and 46% of the patients, respectively. 80% and 60% of the patients with prolonged T1/2 had anorexia and nausea, respectively.
[en] To assess the nutritional status via the SGA (subjective global assessment) screening tool of patients at all stages of hepatitis C virus (HCV) liver disease. Study Design: Descriptive study. Place and Duration of Study: Out-patient Clinics of the Aga Khan University Hospital, Karachi, conducted from October 2009 to January 2011. Methodology: Patients with hepatitis C virus infection and their HCV-negative attendants were enrolled from the outpatient clinics, and categorized into 4 groups of 100 patients each: healthy controls (HC), those with chronic hepatitis C infection (CHC), compensated cirrhotics (CC) and decompensated cirrhotics (DC). The validated subjective global assessment (SGA) tool was used to assess nutritional status. Results: A total of 400 patients were enrolled. Most of the patients in the HC group were class 'A' (best nutritional status). In contrast, the majority (64%) in the DC group were in the class 'C' (worst status). The compensated cirrhosis (CC) group showed that 90% of patients were malnourished, while 98% of all patients were malnourished in the DC group, predominantly class 'C'. Most importantly, 14% of patients with chronic hepatitis C (CHC) also scored a 'B' on the SGA; which when compared to HC was statistically significant (p=0.005). As the groups progressed in their disease from CHC to DC, the transition in nutritional status from 'A' to 'C' between groups was statistically significant. Conclusion: Malnutrition occurs early in the course of HCV, and progresses relentlessly throughout the spectrum of HCV disease. (author)
[en] Chylothorax and chyloascites is the accumulation of chyle in pleural and peritoneal spaces and are rarely seen. This case report describes the occurrence and management in an old lady. However, she expired due to frank haematemesis and encephalopathy. Chylothorax/chyloascites are difficult to manage and associated with poor prognosis. (author)
[en] Thirty-eight patients with cirrhosis of the liver and thirty-seven controls were examined by dynamic computer tomography in a prospective study. Time-density difference curves for the liver, spleen, portal vein, aorta and vena cava were treated mathematically ('gamma fit'). Comparison of the values of the difference curves of liver, spleen and portal vein showed significantly lower and delayed peaks in patients with cirrhosis than in normal people. The time-density difference curves of the liver showed a highly significant shallow decline in the presence of cirrhosis. Discriminant analysis of the curve parameters using the spleen showed differentiation between normals and cirrhosis patients of 90.2%, and using the liver curve a separation of 83%. Combining these parameters of liver and spleen curves improved the separation between cirrhotic patients and normals to 94%. (orig.)
[de]In einer prospektiven Studie wurden dynamische computertomographische Untersuchungen bei 38 Patienten mit Leberzirrhose und bei 37 Kontrollpatienten durchgefuehrt. Den Zeit-Dichte-Differenzkurven (ZDD-Kurven) ueber Leber, Milz, Vena portae, Aorta und Vena cava wurden Kurven nach dem Prinzip der kleinsten Fehlerquadrate mathematisch angepasst ('Gamma-Fit'). Ein Vergleich der so gewonnenen Kurvenparameter zeigte bei ZDD-Kurven von Leber, Milz und Vena portae bei Zirrhosekranken gegenueber einem Normalkollektiv signifikant geringere Kurvenmaxima und verspaetete Gipfelzeiten. Die Zeit-Dichte-Differenzkurven ueber der Leber hatten bei Zirrhose einen hochsignifikant flacheren Abfall. Nach Organen getrennte Diskriminanzanalysen der Kurvenparameter zeigten aufgrund von Milzkurven eine Gruppentrennung zwischen Normalen und Zirrhosekranken von 90,2%, aufgrund der Leberkurven eine Gruppentrennung von 83%. Eine kombinierte Auswertung der Kurvenparameter von Leber und Milz erhoehte die Gruppentrennung zwischen Zirrhosekollektiv und normaler Kontrollgruppe auf 94%. (orig.)
[en] Primary membranous or segmental stenosis of the hepatic portion of IVC is rare condition. The authors experienced a case of segmental stenosis of hepatic portion of IVC in 44 years old woman, and treated successfully by percutaneous transluminal angioplasty (PTA). Progressive gradual dilatation of the conical stenosis was done using 9F balloon catheters (ballon diameter 8mm, 15mm and 20mm, respectively). PTA should be tried before proceeding to operative treatment because of its simplicity and safety.
[en] Very little information is available on body composition in patients with cirrhosis. Difficulties arise in studying these patients because they tend to retain fluid and this results in changes in tissue density and in the hydration fraction of fat-free mass. As the classic body composition techniques rely on the assumption that these variables remain constant, use of these methods will result in either under- or overestimates of body composition variables. Use of multi-component models, employing two or more measurement techniques, will obviate the need for some of the assumptions inherent in the use of single techniques, thereby increasing the accuracy of the assessments, without loss or precision. (orig.)
[en] Objective: To assess the effects of hepatitis B vaccination on the antibody titer in patients with chronic hepatitis C and to compare it with response in normal healthy subjects. Study Design: Interventional study. Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, from January 2007 to January 2012. Methodology: Hepatitis vaccination (Heberbiovac-HB 20) was given intramuscularly to the patients of chronic hepatitis C (HCV group) and normal healthy subjects (control group) at 0, 1 and 6 months intervals. Anti-HBs titer was determined after second and third injection to assess the antibody response. Results: There were 46 patients in the HCV group and 45 patients in the control group. Mean age was 40.9 A +- 9.8 years in the HCV group and 33.18 A +- 8.35 years in the control group. Weight was 67.04 A +- 13.5 kg in the HCV group and 71.78 A +- 14.63 kg in the control group. Height was 162.45 A +- 9.06 cm in the HCV group and 167.03 A +- 7.83 cm in the control group. Anti-HBs antibody levels after the second injection were 253.89 A +- 76.76 mlU/mL in the HCV group and 245.81 A +- 72.65 mlU/mL in the control group (p=0.172). After third injection, the antibody levels were slightly higher in both groups. Conclusion: In patients with chronic hepatitis C and normal healthy subjects, Heberbiovac HB in standard dosage gave sero-protective levels in both groups and antibody titers were not significantly different in control and HCV group. (author)
[en] We discuss the dynamic of a stochastic hepatitis B epidemic model. A stochastic hepatitis B model is formulated with a varying population environment for a long term behavior. The proposed model consists of three classes, namely the susceptible individuals in which the transmission rate is distributed by white noise, the infected individuals in which the same perturbation occurs and the recovered individuals. We derive sufficient conditions for the extinction and the persistence. Finally, we carry out the numerical simulations to support our analytical results.
[en] This study was conducted on prisoners of Central Jail, Bahawalpur and on blood donors at Blood Bank Bahawal Victoria Hospital (BVD), Bahawalpur from 1st August 2005 to 30th November 2005. The intension was to study the sero prevalence of hepatitis Band C in prisoners and to note risk factor if any predisposing to the infection. All the prisoners of central jail Bahawalpur present during the study period, aged more than 18 years of either sex were included as the study group and a comparative group was blood donors presenting to blood bank BVH, Bahawalpur during this period. All the cases in study group (2086) as well as control group (9714) were screened for hepatitis B (HBs Ag) and hepatitis C (anti-HCV) infection detected on serum by One Step Test Device. All the positive cases were confirmed by Enzyme Linked Immunosorbent Assay. After an explanation, verbal consent was taken and a questionnaire was filled before taking samples from all the study group cases. On the basis of screening, prisoners were decided into seropositive group and sero-negative group. The different variable applied on both the groups were age, sex, occupation, residence, marital status, self shaving / by barber, family history of (H/o) jaundice, H/o blood trans-fusion, operation, tattooing and body piercing, drug abuse, same sex / extramarital sex and hepatitis B vaccination status. Total prisoners screened were 2086. Out of them 2072 were males (99.3%). Mean age was 34 years. Total seropositive cases were 249 (11.9%) While during the same period seropositivity in blood donors (control group) was 5.9%. Seropositivity of HBV was 5.6% in study group and 3.1% in control group (p<0.001), HCV was 6.3% Vs 2.8% (p<0.001), statistically very significant difference. Risk factors analysis among prisoners revealed that drug abuse was significantly associated with seropositivity (27% Vs 12%, p value <0.001). Among drug abusers, very high percentage of intravenous drug users was positive (89.2%, 25 out of 28). Prisoners shaved by barber were also at higher risk than self shaving (p value <0.001). H/o operation (p<0.02) and rural origin (p<0.02) were other significant risk factors. Other risk factors evaluated were not statistically significant. Sero prevalence of hepatitis, both B and C is more in prison inmate than healthy blood donors. Main risk factor in them is drug abuse, especially intravenous. Other significant risk factor is shaving by harbor. There is a need to make some strategy to reduce the risk factors. (author)