Evaluation of rifaximin in management of hepatic encephalopathy.

This study evaluated the efficacy of rifaximin versus lactulose in the treatment of hepatic encephalopathy (HE). The study population included 50 patients who were diagnosed to have signs of the first to third degree HE, according to the West Haven criteria and classified into two groups. GI: included 25 patients who had HE and were treated with lactulose syrup (laxolac) 90 ml daily divided into 3 doses for 7 days. GII: included 25 patients who had HE and were treated with rifaximin 1200 mg daily divided into 3 doses for 7 days. Patients in both groups also received other measures of treatment of HE as daily enema and protein restriction. Rifaximin significantly improved various subjective and measurable components of HE including mental status, behavior, asterixis, and serum ammonia concentration. In acute HE of grade 1 to grade 3, rifaximin may be a good alternative to non-absorbable disaccharides as it is broad spectrum, non-absorbable antibiotic with rapid action and little side effects. It is better tolerated, associated with less frequent and shorter hospitalization in comparison to lactulose.

Natural infection of baboons by Entamoeba histolytica elicits anti- gal-lectin heavy subunit IgA and IgG antibodies with shared epitope specificity to that of humans.

Non-human primates, such as baboons (Papio hamadryas anubis), are natural hosts for Entamoeba species; infections can be asymptomatic or result in invasive lethal disease. It was sought to determine whether following natural infection by Entamoeba. histolytica, baboon anti-amebic antibodies recognized native Gallectin, a recombinant portion of the lectin heavy subunit (designated LC3) and specific heavy subunit epitopes; we compared the specificity of anti-amebic antibodies from baboons to that of humans following asymptomatic E. histolytica infection or cure of amebic liver abscess (ALA). Female baboons (n=54), aged one to three years of age and living in captivity were screened for infection by real time PCR. E. histolytica infection was found in 37 baboons and was associated with serum anti-LC3 IgG (73%) and anti-LC3 IgA (46%) or intestinal anti-Gal-Lectin IgA antibody responses (49%), p<0.021 for each compared to that observed with baboons having an E. dispar infection (n=10) or uninfected baboons (n=7). The ELISA OD reading for anti-LC3 or anti-lectin antibodies correlated strongly with the presence of a PCR CT value indicative of E. histolytica infection. In humans with asymptomatic E. histolytica infection or those recently cured of ALA, 63% and 57% had serum anti- LC3 IgA and 65% and 57% had serum anti-LC3 IgG antibodies respectively. Epitope- specific synthetic peptides were used as capture antigens in ELISA; for baboons that possessed anti-LC3 and anti-lectin antibodies, 74% had anti-peptide IgG or IgA antibodies, compared to 86% of asymptomatic humans and 92% of ALA subjects(P>0.05).

Prognostic and predictive values of MELD score, platelet count and pre-albumin in patients with compensated and decompensated liver cirrhosis with acute variceal bleeding.

The study included 190 patients divided in to 5 groups: 20 normal as healthy control complaining of dyspepsia, GERD etc., 20 patients positive HCV without cirrhosis or varices, 50 patients compensated cirrhosis with varices, 50 patients decompensated cirrhosis with varices and 50 patients with primary acute variceal bleeding. All were subjected to full history taking, clinical examination, routine laboratory examinations including serum pre-albumin, abdominal ultrasonography, MELD score was calculated for all patients, Child classification for all patient and upper gastrointestinal endoscopy. The results showed that platelet count was lowest in patients with varices, decrease of platelet count with increase of grading of esophageal varices. Platelet count was lowest in patients with early bleeding esophageal varices at 6 weeks in comparison to patients with bleeding esophageal varices at 4 months and patients with bleeding esophageal varices at 6 months. MELD score proved to be sensitive and specific in differentiation between patients with and without varices. The increasing of MELD score with increase of grade of varices pre albumin (PA) was lowest in patient with esophageal variceS and decrease of PA level with increase of grade of varices.