Background and study aim: The most common infection in decompensated hepatic patients with cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The aim of this work is to assess the value of calprotectin in ascitic fluid in diagnosis of spontaneous bacterial peritonitis in patients with liver cirrhosis. Patients and Methods: In this cross section study, 80 cirrhotic patients were divided into (group A) 40 patients with non SBP and (group B) 40 patients with SBP, who attended the Hepatology Department Benha University Hospital. All the patients were evaluated by thorough history, clinical examination, laboratory investigations, ultrasonongraphy, diagnostic paracentesis with PMNLs count and Calprotectin which was measured in 1 mL ascetic fluid by ELIZA. Results: Calprotectin was high in SBP group with a highly statistical significant difference in SBP group compared to non SBP group so it can serve as a sensitive and specific diagnostic test for detection of SBP in cirrhotic patients with ascites. The sensitivity of the test was 90% with specificity of 62.5%, PPV of 70.5% and NPV of 86.5% with the cutoff level were 2.98 ng /ml and the area under the curve was 0.88. Conclusion: Ascitic calprotectin reliably predicts PMN count >250/μL, which may prove useful in the diagnosis of SBP, especially with a readily available bedside testing device.
Background & Aims:
Hepatocellular carcinoma (HCC) is the fifth most common cancer
and the second leading cause of cancer-related deaths. The only definitive treatment for both HCC
and cirrhosis is liver transplantation, but long wait times in some regions and a relatively fixed
number of donor organs negatively impact access to liver transplantation. The aim of the work was
to evaluate and compare the short outcome of patients with medium-sized HCC who will undergo
percutaneous microwave ablation (MWA) alone and in combination with TACE.
Methods:
This prospective study included 40 patients with medium-sized HCC lesions who were
classified into two groups; Group A that included twenty patients treated by TACE followed by percutaneous MWA after 2 weeks and group B that included twenty patients treated by 2 sessions of
percutaneous MWA with 2 weeks interval. Full history taking, clinical examination, laboratory investigation, abdominal ultrasonography and abdominal tri-phasic computed tomography (CT) with
contrast were obtained from the two groups. Laboratory and radiological follow up of the cases
were done at 1 and 3 months after the treatment.
Results:
There was no statistically significant difference in the sociodemographic criteria, laboratory measurement and clinical criteria between the cases in the two study groups before initiation of
treatment. The response was slightly better in the combined treatment group, but it did not show a
statistically significant difference. The incidence of complications was higher in the MWA group.
Conclusion::
Hepatocellular carcinoma is a common complication of HCV related cirrhosis. Association of TACE-MWA led to better response rates than MWA with fewer complications.
Background: Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of ascitic fluid. Generally, no source of the infecting agent is easily identifiable. The aim of this work was to identify the most suitable antibiotic to describe for empiric therapy of spontaneous bacterial peritonitis (SBP) in Egyptian patients with liver cirrhosis and ascites. Methods: This study was carried out on 80 cirrhotic patients from Benha university hospitals and Ahmed Maher Teaching hospital underwent ascetic fluid analysis for PMN cell count and culture\sensitivity, Thorough history taking, full general and local examination, full investigations, serological tests for viral markers, modified Child's Pugh classification, abdominal ultrasonography and diagnostic abdominal paracentesis. Results: PMN cell count of all studied patients was over 250 cells/µL, 30 patients (37.5%) their culture were negative (no growth organisms) which is a large variant of SBP called culture negative neutrocytic ascites,50 patients (62.5%) their culture was positive. For gram stain negative organisms 41 patient (82%), E. coli (53.66%) mostly sensitive to cefotaxime (80%), ceftriaxone (87.50%), cefoperazone (76.92%), out of the 22 E. coli 4 (18.18%) were multidrug resistant, 3 (13.64%) were extensive drug resistant. For gram stain positive organisms 9 (18%), Staphylococcus aureus (77.78%) mostly sensitive to trimethoprim\sulphamethoxasole (100%), vancomycin (85.7%), linezolid (100%), out of 5 staphylococcus aureus 4 (57.14%) were multidrug resistant, 1 (20%) was extensive drug resistant.
Conclusion:If PMN cell count more than 250 cells/µL should start empirical third generation cephalosporin antimicrobial treatment for 10 to 14 days even if culture\sensitivity result is negative. Amikacin & cefepime should be considered in empirical antimicrobial therapy in spontaneous bacterial peritonitis with dose adjustment according to creatinine clearance.
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