Background Hepatic encephalopathy exacerbates the morbidity, delays hospital discharge, and increases the rate of readmissions of cirrhotic patients, particularly those are admitted by acute variceal bleeding. We evaluated the performance of albumin-bilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding, in comparison to Child-Pugh and MELD scores. This prospective cohort study was conducted on 250 cirrhotic patients who were consecutively presented by acute variceal bleeding in the period from January to December 2020 at Tanta university emergency hospital. Albumin-bilirubin, Child-Pugh, and MELD scores were measured at admission, and then all patients were followed up for 4 weeks after endoscopic bleeding control for possible occurrence of hepatic encephalopathy Results Albumin-bilirubin, Child-Pugh, and MELD scores had significant performances in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding; in this regard, albumin-bilirubin score had the highest accuracy (AUC 0.858, CI 0.802-0.914, sig 0.000) followed by Child-Pugh score (AUC 0.654, CI 0.574–0.735, sig 0.001) and then MELD score (AUC 0.602, CI 0.519–0.686, sig 0.031). The cumulative incidence of hepatic encephalopathy in cirrhotic patients with albumin-bilirubin grade 3 was found to be significantly more than that present in albumin-bilirubin grade 2; most of these hepatic encephalopathy cases occurred in the first 2 weeks of follow-up period. Conclusions Albumin-bilirubin score has a significant performance in risk prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding better than Child-Pugh and MELD scores. Albumin-bilirubin grades could be used as a risk stratifying tool to triage cirrhotic patients who will benefit from early discharge after bleeding control and those patients who will benefit from prophylactic measures for hepatic encephalopathy.
Background: Increase prevalence of obesity is linked with increase the threat of various diseases such as cardiovascular disease, diabetes, cancer, and many gastrointestinal complications of obesity. Objective: Study the relationship between obesity, endoscopic gastritis, and serum Adiponectin level in obese persons. Methods: This study was done on sixty-five patients diagnosed with chronic gastritis by upper endoscopy according to Sydney system, categorized into three groups according to their body mass index, group A: Body Mass Index less than 25, group B: Body Mass Index from 25 to 30 and group C: Body Mass Index more than 30. Careful clinical examination, Complete Blood Count, lipid profile, Helicobacter pylori antigen in the stool and serum Adiponectin by Enzyme Linked Immonosorbent Assay technique were done. Results: Body Mass Index showed statistically significant difference between all studied groups. 49.2% of our study patients had erosive gastritis, 29.9% had hemorrhagic gastritis and 21.5% had atrophic gastritis. Serum Adiponectin showed statistically significant difference between all studied groups. According to Receiver operating characteristic curve of serum Adiponectin, a cut off level lower than 7 microgram/ml is diagnostic of endoscopic gastritis in obese persons with Area under Curve about 0.841, sensitivity of 86%, specificity of 73%, negative predictive value of 81%, and positive predictive value of 79% and accuracy of 80%. Lower Adiponectin level was found in erosive gastritis compared to hemorrhagic and atrophic gastritis. Erosive gastritis had the highest Body Mass Index followed by hemorrhagic and the least was atrophic gastritis group (p-value < 0.05). Conclusion:Obese subjects have a lower serum Adiponectin level which may be a risk factor of incidence of gastritis and may affect its types.
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Introduction: The prognosis of chronic myeloid leukemia (CML) patients has been dramatically improved with the introduction of imatinib (IM), the first tyrosine kinase inhibitor (TKI). TKI resistance is a serious problem in IM-based therapy. The human S-phase kinase-associated protein 2 (SKP2) gene may play an essential role in the genesis and progression of CML. Aim of the study: We try to explore the diagnostic/prognostic impact of SKP2 gene expression to predict treatment response in first-line IM-treated CML patients at an early response stage. Patients and methods: The gene expression and protein levels of SKP2 were determined using quantitative RT-PCR and ELISA in 100 newly diagnosed CML patients and 100 healthy subjects. Results: SKP2 gene expression and SKP2 protein levels were significantly upregulated in CML patients compared to the control group. The receiver operating characteristic (ROC) analysis for the SKP2 gene expression level, which that differentiated the CML patients from the healthy subjects, yielded a sensitivity of 86.0% and a specificity of 82.0%, with an area under the curve (AUC) of 0.958 (p < 0.001). The ROC analysis for the SKP2 gene expression level, which differentiated optimally from the warning/failure responses, yielded a sensitivity of 70.59% and a specificity of 71.21%, with an AUC of 0.815 (p < 0.001). Conclusion: The SKP2 gene could be an additional diagnostic and an independent prognostic marker for predicting treatment responses in first-line IM-treated CML patients at an early time point (3 months).
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