Can Endothelin-1 Levels in Patients with Esophageal Variceal Bleeding at Admission Predict Rebleeding Within 5 Days?

BACKGROUND/AIMS: Portal hypertension complicating liver cirrhosis is associated with vascular resistance, possibly due to overexpression of humoral vasoconstrictors, including endothelin. The study aimed to evaluate the efficacy of serum endothelin-1 levels as a noninvasive predictor of early esophageal rebleeding (within 5 days) following endoscopic treatment. MATERIALS AND METHODS: Of the patients presented to the endoscopy unit at Mansoura University Hospital, 50 patients were chosen for this study on the basis of endoscopically proven acute esophageal variceal bleeding consequent to hepatitis C viral infection complicated by liver cirrhosis and portal hypertension. Routine laboratory parameters and serum endothelin-1 levels were assessed prior to endoscopic treatment. Patients were divided into 2 groups depending on the development of early postendoscopic rebleeding. Group A consisted of 16 patients who developed rebleeding, while group B included 34 patients who did not. Statistical analysis was performed to determine the predictors of rebleeding. RESULTS: Multivariate logistic regression demonstrated that endothelin-1 level (P < .001) and serum albumin level (P = .04) were independent risk factors for early rebleeding. The most efficient cutoff value for endothelin-1 levels in predicting variceal rebleeding within the 5 days after endoscopic intervention was 65.29, which had an 88.2% specificity, 87.5% sensitivity, 88% accuracy, and area under the curve value of 0.89. In addition, hemoglobin, albumin, and creatinine levels were significantly different between bleeding and nonrebleeding groups (P = .03, P = .014, and P <.001, respectively), as was the duration of hospital stay (P < .001). CONCLUSION: Serum endothelin-1 levels appear to be a reliable, practical, noninvasive predictor of early variceal rebleeding and related comorbidities such as the severity of kidney affection and duration of hospital stay.

Assessment and outcome of hospitalized patients during delta variant COVID-19 pandemic: A multicenter international study.

INTRODUCTION: To date, the world has experienced four waves of the Coronavirus disease- 19 (COVID-19) pandemic. Patients infected during the era of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant were the subject of this study. The objectives were to describe their clinical manifestations, explain their laboratory and radiological findings, conclude factors contributing to clinical outcomes, and evaluate treatment protocols. METHODOLOGY: Relevant data were collected retrospectively from records of patients admitted to six referral centers in four countries. Data included sociodemographic patterns, symptoms, associated comorbidities, physical examination, laboratory and radiologic findings, treatment received, and patient outcomes. RESULTS: Data analysis identified symptomatology and variables related to acquisition and infection outcome. The most prevalent symptoms were cough (81.5%), body aches (74.1%), and fever (71.6%). Independent risk factors for mortality were age, vomiting, epigastric pain, diabetes, obesity, oxygen saturation less than 90%, leukocytosis, neutrophilia, lymphopenia, thrombocytopenia, elevated creatinine, high glucose level, lung ground glass opacities with consolidation, affection of four lobes and bilateralism. Neither d-dimer nor lactate dehydrogenase nor ferritin foretells death possibility. The efficacy of the medications used was convenient. CONCLUSIONS: Assessing the clinical features of different COVID-19 waves, identifying predictors of outcomes, and concluding the efficacy of treatment protocols provide insight into patients' responses and viral behaviors, which help in the proper diagnosis and treatment of subsequent surges.

Clinical Spectrum of Nonalcoholic Fatty Liver Disease in Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVE: The purpose of this study was to determine the prevalence of nonalcoholic fatty liver disease in a group of chronic obstructive pulmonary disease patients. MATERIAL AND METHODS: This study comprised 48 stable chronic obstructive pulmonary disease patients who were diagnosed and categorized using the Global Initiative for Chronic Obstructive Lung Disease 2017 criteria. The prevalence of nonalcoholic fatty liver disease in chronic obstructive pulmonary disease patients was determined using noninvasive biomarkers and imaging methods. Steatosis was detected using magnetic resonance mDIXON-Quant sequence imaging, while fibrosis was detected using the acoustic radiation force impulse and FIB-4 index. RESULTS: A total of 58.3% of the patients investigated had a fat level of 5%, and nearly a quarter of them had a fat content of 10% or more, and 45.8% of the patients studied had severe hepatic fibrosis. The Fibrosis-4 (FIB-4) index revealed advanced fibrosis in 18.75% of them. No statistically significant association was found between chronic obstructive pulmonary disease groups of studied patients and the presence of steatosis and fibrosis (≥F2) using acoustic radiation force impulse. The presence of fibrosis, however, was statistically significant linked with chronic obstructive pulmonary disease groups of examined patients using the FIB-4 index. γ-Glutamyl transferase and alkaline phosphatase levels were greater in Global Initiative for Chronic Obstructive Lung Disease 3/4 and C/D groups. CONCLUSION: Nonalcoholic fatty liver disease is a common comorbidity in chronic obstructive pulmonary disease and should be included in the list of chronic obstructive pulmonary disease comorbidities.

Prevalence and Predictors of Persistent Symptoms After Clearance of SARS-CoV-2 Infection: A Multicenter Study from Egypt.

Background and Aim: Little is known about the persistence of symptoms after clearance of SARS-CoV-2 infection. Our study aimed to assess persistent symptoms in COVID-19 patients after clearance of SARS-CoV-2 infection. Methodology: A multi-center survey was conducted on first wave COVID-19 patients with confirmed SARS-CoV-2 infection. Sociodemographic and clinical characteristics, including presenting symptoms and persistent symptoms after viral clearance and possible factors contributing to persistence of such symptoms, were collected using an online multicomponent questionnaire. Descriptive and inferential statistical analysis was performed to detect the most persisting symptoms and factors contributing to their persistence. Results: Overall, 538 patients were enrolled. Mean age was 41.17 (±SD 14.84), 54.1% were males, and 18.6% were smokers. Hypertension and diabetes were the most reported co-morbidities. Mild symptoms were reported in 61.3% of patients, 51.3% were admitted to hospital and 6.5% were admitted to the intensive care unit. Our study identified 49 types of persisting symptoms. Fatigue (59.1%), sense of fever (46.5%), anorexia (24.3%) and diarrhea (24.3%) were the most commonly reported persisting symptoms followed by loss of taste and smell (22.3%), headache (21.4%), cough (20.8) and dyspnea (21%). The use of hydroxychloroquine, azithromycin and multivitamins were significantly associated with persistence of symptoms (OR = 8.03, 8.89 and 10.12, respectively). Conclusion: Our study revealed that in COVID-19 recovered patients, many patients reported persistence of at least one symptom, particularly fatigue and sense of fever. Follow-up of patients after discharge from hospital is recommended until complete resolution of symptoms.

New Cutoff Point for Platelet Count/Spleen Diameter Ratio to Predict Esophageal Varices in Patients with Hepatitis C Virus-related Hepatic Cirrhosis.

The esophagogastroduodenoscopy (EGD) with all its hazards remains the gold standard screening tool for esophageal varices. Noninvasive tools have been proposed and studied to replace the EGD. Platelet count (PC)/spleen diameter (SD) ratio as a noninvasive tool for predicting the presence of esophageal varices was proposed and studied in many previous studies. HOW TO CITE THIS ARTICLE: El-Sherbiny W, Elegezy M, Shaltout SW. New Cutoff Point for Platelet Count/ Spleen Diameter Ratio to Predict Esophageal Varices in Patients with Hepatitis C Virus-related Hepatic Cirrhosis. Euroasian J Hepato-Gastroenterol 2015;5(2):136-137.