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Article
The Value of Using Echocardiography in Patients of Advanced Liver Disease with Cardio Pulmonary Complications

Authors: Basil. N. Saeed --- Sameer Hakeam --- Lutf Ahmed --- Jalal Ahmed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 4 Pages: 323-326
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Patients with chronic liver disease are liable to get cardio – pulmonary complications, one of these complications is development of pulmonary hypertension ranging from mild to it's sever form – this complication could give some abnormal findings in chest x-ray, electrocardiography but more prominently by echocardiography.OBJECTIVES:To clarify the benefit of using the echocardiogram is detecting pulmonary hypertension prior to the use of invasive methods (catheterization) in patients with advanced liver disease.METHODS:A total of 50 patients with chronic liver diseases (cirrhosis, chronic active hepatitis) their age range is (25-70 years) (mean are 37.07 years), the fifty patients were free from any cardiac or respiratory diseases.The study extending from December 2007-August 2008. All patients went through full history and routine blood test: including complete blood picture, fasting blood sugar, blood urea & screatinne, lipid profile, liver function tests, clinical examination, and investigations included routine blood test, chest x-ray, and electrocardiography, echocardiography (Transthoracie and transoesphageal). The child-Pugh score used for assessing the severity and prognosis of chronic liver disease and it classified into three groups (A, B, C) used in this study.RESULTS:Fifteen patients from the 50 cases (30%) only proved to have cardio-pulmonary changes (i.e. pulmonary hypertension right ventricular hypertrophy and dilatation with the mean value of ≥ 25mm Hg at rest or ≥ 30mm Hg during exertion) those patients were having fatigue in (70%) of them while dysponea, chest pain, cyanosis, syncope were detected in 30%, 10%, 1%, 2% respectively in those cases of pulmonary hypertension with chronic liver disease.CONCLUSION:The use of non invasive methods especially echocardiography were helpful in detecting the presence of pulmonary hypertension in patients with chronic liver disease


Article
Rheumatological manifestations of chronic viral hepatitis

Author: Abbas T. Joda
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2012 Volume: 11 Issue: 2 Pages: 1-6
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Aims: To evaluate and assess the rate of rheumatological manifestationsin patients with chronic viral hepatitis.Patients and Methods: Sixty four patients with chronic viral hepatitiswere included in this cross-sectional study. The diagnosis of viralhepatitis is established by clinical & laboratory study.Full history was taken from all patients with special concentration onrheumatological manifestations and complete clinical examination wasdone for all of them, blood test including liver function tests, viralserology, viral load, and renal function.Results: All together, sixty four patients were recruited and studied, fifty(32males and 18 females) of them (78.1%) had shown rheumatologicalmanifestations. Thirty one of patients were reported with HCV infection& 19 patients with HBV infection. The rate of chronic fatigue wasreported in 24 patients (48%). Myalgia was presents in 21patients (42%)which was more in patients with HCV. Arthralgia was present in 19patients (38%). Sicca syndrome was presented in 12 patients (24%).Schirmer's test was positive in 2 patients (4%). Skin rash occur in 6patients (11.1%). It's nonspecific purpuric rash, Arthritis was reported in 3patients (6%), all of them with HCV infection. Also there were 16 patients(32%) of all patients on treatment with interferon-alpha or antivirusmeasure or both.Conclusions: Chronic viral hepatitis infection patients shows variousrheumatological manifestations in more than 75% of cases so it issuggested to investigate patients with unexplained rheumatologicalmanifestations who are at risk for viral hepatitis for these viral infections


Article
The Effect of Chronic liver diseases on homocysteine and vitamin B12 in patients serum

Author: Essam F. Al-Jumaily * BSc, PhD د. عصام الجميلي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2009 Volume: 51 Issue: 4 Pages: 399-402
Publisher: Baghdad University جامعة بغداد

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Abstract

Summary:Background: Homocysteine (Hcy) is a sulfur containing amino acid that is formed as an intermediary in methionine metabolism. Raised plasma homocysteine levels, which may contribute to the increased risk of chronic liver disease. Patients and Methods: Sixty two patients with chronic liver disease and 26 healthy individuals were included as normal controls for the study. The HPLC system was used for the determination of Hcy and vitamin B12. Results: A highly significant Hcy concentrations were noted in all patients with cirrhosis, chronic hepatitis or liver mass. There was a trendency towards higher Hcy concentrations in more advanced stages of liver disease. The study showed that the concentrations of total Hcy were significantly higher in the patients than in the normal control group, irrespective of the age or gender. Mean serum concentration of vitamin B12 were significantly increased in cirrhotic patients and those with liver cancer compared to the control subjects and chronic hepatitis symptomatic patients. Conclusion: The serum levels of both homocystein (Hcy) and vit. B12 were significantly increased in cirrhotic patients and those with liver cancer compared to chronic hepatitis symptomatic patients.Key words: chronic liver disease, homocysteine, vitamin B12.


Article
THE VALUES OF HYALURONIC ACID AND AS A MARKER OF CIRRHOSIS IN CHILDREN WITH CHRONIC LIVER DISEASES

Authors: Nadia N Hassan نادية نوري حسن --- Firyal H Al-Obaidi فريال حسن العبيدي --- Hala S Arif هاله سامح عارف
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 1 Pages: 72-77
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Hyaluronic acid (HA) is removed by the liver via sinusoidal cell adhesion molecules. This is impeded in fibrosis, leading to a rise in serum HA. As a noninvasive marker of fibrosis, HA may obviate the need for liver biopsy.Objective:To evaluate HA as a marker of hepatic fibrosis in unselected children undergoing liver biopsy or ultrasound.Methods:Fifty children aged 2-156 months diagnosed to have different types of chronic liver diseases (CLDs) and thirty healthy children aged 2-156 months were studied as controls were evaluated at the Teaching Hospital and Gastroenterology and Hepatology Center, Medical City, Baghdad, Iraq. The degree of severity of liver infection was assessed by liver biopsy or ultrasound. HA levels were measured using an ELISA.Results:The mean of HA level was 0.61± 0.32 ng/ml in the control group, 3.05± 1.11 ng/ml in patients with significant fibrosis and 1.18±0.86 ng/ml in patients with chronic liver diseases without significant fibrosis. Significant fibrosis was found in 31 out of 50 children with chronic liver disease, 20 of them were classified (METAVIR score) as cirrhotic liver. Seven out of 18 biopsies value of stage 4. Thirteen out of 32 ultrasounds described as having a coarsely textured liver. The sensitivity and specificity of estimated HA values in the diagnosis of liver cirrhosis were 87.1% and 94.74%, respectively.Conclusion:HA is a valid noninvasive predictor of histological fibrosis in children with CLD. It complements the thorough investigations of a child with CLD; however, it cannot at present replace histological examination to identify liver fibrosis. Further evaluation of HA is needed to ascertain the use of serial measurements in the targeted patient groups.Key word:Hyaluronic acid, chronic liver disease, liver fibrosis.


Article
Hepatitis G virus infection among Iraqi patients with Chronic liver diseases

Authors: Faiza A.Mukhlis فايزة احمد --- Shatha F. Abdullah شذى فاروق --- Eman Sh.Al-Obeidy ايمان العبيدي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2010 Volume: 52 Issue: 3 Pages: 299-303
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The hepatitis G virus( HGV), also called hepatitis GB virus, as a member of the Flaviviridae family distantly related to hepatitis C virus (HCV), Little is known about the frequency of HGV infection, the nature of the illness, or how to prevent it. What is known is that transfused blood containing HGV has caused some cases of hepatitis. They infect humans, but are not known to cause human disease. This virus can be transmitted efficiently by blood transfusion and by other parenteral mechanisms. Transient and long lasting infections with HGV have been documented in man.Patients and methods: HBs Ag, Anti-HCV IgG and Anti-HGV IgG were detected by Enzyme-Linked Immunosorbent Assay (ELISA).HCV RNA on the other hand, has been detected using PCR technique in the serum of 75 Iraqi patients with chronic liver diseases in comparison to 15 healthy individuals.Results: HGV infection was detected in 25% of blood donors, 30% of chronic hepatitis C, 25% of chronic hepatitis B, and 20% of cryptogenic chronic liver disease. HGV infected patients tended to be younger than non-infected patients but no differences concerning sex, possible source of infection, clinical manifestations, biochemical and virological parameters, or severity of liver lesions were found.Conclusions: The percentage of HGV infection in chronic liver disease seems to be relatively high in our area 19 out of 90cases (21.11%). Infection with HGV does not seem to play a significant pathogenic role in patients with chronic liver disease related to chronic HBV or HCV infection, or in those with cryptogenic chronic liver disease. Key words: HGV, chronic liver disease, blood donors.


Article
Demographic Factors Influencing Hepatitis B infection towards Bad Prognosis in a Sample of Iraqi Patients
العوامل الديموغرافية المؤثرة في مرض التهاب الكبد الفيروسي البائي باتجاه المآل السيئ في عينة من المرضى العراقيين

Authors: Maysaa K. AL-Malkey ميـساء كاظـم المالكي --- Lina Talal لينا طلال --- Istabreq Abudel Al-Hadi استبرق عبد الهادي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2008 Volume: 21 Issue: 1 Pages: 24-29
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Objective: This study was design to identify the predisposing factors affecting patients with hepatitis B towards chronic infection and bad prognosis such as chronic liver disease, liver cirrhosis and death. Patients & Methods: Data were collected from records of Digestive System and Liver Diseases Teaching Hospital in Baghdad about patients infected with HBV as well as basic demographic data, statistical analysis was performed using Chi-square test.Results: The infection rate was increased from 3% in 2001 to 35% in 2004 but the case-fatality rate was decreased from 40% in 2001 to 22% in 2004. The chronic liver disease recorded 72.5% and the liver cirrhosis recorded 5.5%.Conclusion: The early diagnosis of the disease and presence of medical professionals (gastroenterologists and hematologists) lead to minimize further bad prognosis which result in minimizing the deaths of patients in spite of increasing the rate of the disease in the few past years. Key words: HBV, chronic liver disease, liver cirrhosis, bad prognosis

الهدف : تهدف الدراسة للتعرف على العوامل الديموغرافية المؤثرة على المرضى المصابين بالتهاب الكبد الفيروسي البائي باتجاه المآل السيئ نحو الإصابة بالتهاب الكبد المزمن وتشمع الكبد والموت.طريقة العمل : تم جمع البيانات الخاصة حول المرضى المصابين بالتهاب الكبد الفيروسي البائي من مستشفى الجهاز الهضمي وأمراض الكبد التعليمي في بغداد بالإضافة إلى جمع المعلومات السكانية وتم تحليل هذه البيانات إحصائيا باستخدام Chi - square test .النتائج : أن معدل الإصابة أزداد من 3% في سنة 2001 إلى 35% في سنة 2004 ولكن نسبة الوفيات سجلت انخفاضاً من 40% في سنة 2001 على 22% في سنة 2004. سجل مرض التهاب الكبد المزمن نسبة 72.5% وسجل مرض تشمع الكبد نسبة 5.5%. الاستنتاجات : أن التشخيص المبكر للمرض ووجود أطباء متخصصين قلل من المآل السيئ للمرض وبالتالي قلل نسبة الوفيات بالرغم من ازدياد المرض خلال السنوات الماضية.


Article
Platelets Count As A Predictor For Portal Hypertension in Patients With Ascites

Authors: Sadiq J. Almuhana --- Ali Kadim Radi --- Lath Abdulhussein --- Abbas Al-dabbagh
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2014 Volume: 11 Issue: 4 Pages: 851-857
Publisher: Babylon University جامعة بابل

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Abstract

Background: Serum Ascetic Albumin Gradient is a good biochemical marker and a better discriminator of portal hypertension. Patients with gradients of >1.1 g/dL have portal hypertension, while those with gradients of <1.1 g/dL do not, with accuracy rate 97% and sensitivity of 100%. Thrombocytopenia is a frequent and challenging clinical disorder in patients with portal hypertension. The most sensitive and specific laboratory finding suggestive of cirrhosis in the setting of chronic liver disease is a low platelet count (<150×109/L), which occurs as a result of portal hypertension and hypersplenism. Aim of Study:To predict the presence of portal hypertension in patient with ascites by measuring the platelets count.Patients and Methods: Fifty patients with ascites were sent for complete blood picture, serum albumin, echo study, abdominal ultrasound and albumin in ascites fluid along with thorough medical history and examination. we calculate the SAAG for all patients and classified into two groups , the first has SAAG> 1.1 g/dl and considered to have portal hypertension, the second has SAAG <1.1 g/dl. Results: In this study, 50 patients with ascites their ages ranges from (34-60) years ,25 of them had SAAG more than 1.1g/dl , 20 of them had platelet count <150×109/L. while 25 patients with SAAG less than 1.1g/dl, 7 of them had platelet count <150×109/L. this indicate significant correlation between low platelet count and portal hypertension(p value 0.0002)(the measured sensitivity=84%, specificity=76%, P.P.V=77%, N.P.V=82%) . Another significant correlation was seen between splenomegaly detected by U/S and portal hypertension, 25 patient had SAAG more than 1.1g/dl, of them 12 had splenomegaly ( p value 0.00039)(the measured sensitivity=48%, specificity=96%, P.P.V=92%, N.P.V=64%)Conclusion: Thrombocytopenia in patient with ascites may predict portal hypertension.

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