Background and Aims: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D deficiency has a central role in developing hepatic osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their relationship with disease advancement in these patients.Methods: Vitamin D levels were checked in 125 chronic liver disease patients. The patients were classified in three stages according to Child-Pugh score: A, B and C. The relationship of vitamin D levels with Child-Pugh score and other variables in the study was assessed by the contingency coefficient. Correlation and logistic regression analyses were also carried out to find additional predictors of low vitamin D levels.Results: Among the patients, 88% had either insufficient or deficient stores of vitamin D, while only 12% had sufficient vitamin D levels (p >0.05). Vitamin D levels were notably related to Child-Pugh class (contingency coefficient = 0.5, p <0.05). On univariate and multinomial regression analyses, age, female sex, MELD and Child-Pugh class were predictors of low vitamin D levels. Age, model of end-stage liver disease score and Child-Pugh score were negatively correlated to vitamin D levels (p <0.05).Conclusions: Vitamin D deficiency is notably related to age, female sex and model of end-stage liver disease score, in addition to Child-Pugh class of liver cirrhosis. Vitamin D levels should be routinely checked in patients with advanced liver cirrhosis (Child-Pugh class B and C) and this deficiency must be addressed in a timely manner to improve general well-being of cirrhotic patients.

Background/Aims: Endoscopy as a screening modality for esophageal varices is becoming difficult because of its invasiveness, cost, and increased burden of liver cirrhosis. This study aims to determine the diagnostic accuracy of simple and noninvasive markers in detecting esophageal varices. Materials and Methods: Four variables (platelet count, portal vein diameter, splenic diameter, and ratio of platelet count to splenic diameter PC/SD] ratio) were studied in 150 cirrhotic patients. Endoscopy was performed to detect esophageal varices in the patients. The diagnostic accuracy of these variables was determined by obtaining area under the receiver operating characteristic (ROC) curve (AUC). The cutoff value of each variable and its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were obtained using the Youden index. Pairwise comparison of these variables was performed using the Hanley and McNeil method to determine the most reliable screening tool among them. Results: The PC/SD ratio was the most reliable indicator for the presence of varices: AUC=0.9 (p<0.0001; cutoff value, ≤1077.42; sensitivity, 88.75%; specificity, 81.43%). The AUC for platelets and splenic diameter was 0.85 (p<0.0001) and 0.77 (p<0.0001), respectively, showing they were also good indicators. The portal vein diameter was not a good predictor for esophageal varices (AUC=0.59). Pairwise comparison of these variables showed that the PC/SD ratio is statistically significant for predicting esophageal varices among these markers (p<0.05). Conclusion: The PC/SD ratio is found to be the most reliable marker to prognosticate esophageal varices. It is easy to obtain and can be used with other markers to identify the high-risk patients for developing esophageal varices. It will definitely reduce the need for endoscopy as screening purposes and lower the medical expenditures.

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BackgroundThe annual global deaths from viral hepatitis is 1.4 million. Pakistan has the second highest burden of hepatitis C in the world. There is dire need to evaluate the response of new direct acting antivirals for the treatment of hepatitis C patients in Pakistan. World Health Organization has developed a strategy to treat 80% of HCV patients by 2030. In Pakistan, HCV treatment rate is 1%. The aim of the study was to analyze the effect of Sofosbuvir plus Ribavirin therapy on HCV patients in Pakistan.MethodsAn observational study was conducted at Fauji Foundation Hospital Rawalpindi from November-2016 to July-2017. All the drugs were administered according to the guidelines of Asia Pacific Association for the Study of Liver (APASL) for the treatment of HCV patients. A total 327 chronic HCV patients were enrolled in the study and 304 completed the treatment. Patients belonged to three different groups including treatment: Naïve patients (n = 107), Non-Responder patients (n = 126) and patients who relapsed to Interferon therapy (n = 71). All the patients were given Sofosbuvir plus Ribavirin therapy for 24 weeks and the early virological response (EVR) and end treatment response (ETR) was calculated. Different parameters including patient age, viral load, viral genotype, blood picture, ultrasound findings and liver function tests were also studied.ResultsOut of 304 patients, 301 (99%) achieved EVR and 300 achieved ETR (98.7%). End treatment response was 95.6% in HCV genotype 1 and 98.9% in HCV genotype 3 patients. ETR was 99.06% in treatment Naïve, 99.20% in non-responders and 97.18% in previously relapsed patients. We did not find the association of any host and viral factor in the determination of EVR and ETR.ConclusionThe Sofosbuvir plus Ribavirin treatment is highly effective, safe and cost-effective for the treatment of hepatitis C patients in Pakistan.