Causes and Clinical Profiles of Ascites at University of Gondar Hospital, Northwest Ethiopia: Institution-Based Cross-Sectional Study.

Background: Ascites is a common clinical condition encountered by physicians in day-to-day practice. It is caused by various underlying diseases. Knowing the etiologies is vital because further investigations and definitive treatment largely rely on the specific disease entity considered. Objective: The aim of this study was to determine the epidemiology of causes of ascites and complications among patients with ascites from the medical department at the University of Gondar Hospital. Methods: Data on sociodemography, major symptoms, and signs, risk factors, past medical illnesses, and results of important investigations were collected using pretested questionnaires among all patients with ascites in the University of Gondar Hospital in a sample size of 52. Data were collected by well-trained physicians and analyzed by using SPSS 16. Results were depicted descriptively with measures of central tendency, dispersion, and using tables and graphs. Results: A total of 52 patients were included in this study from November 1, 2018 to March 30, 2019. Thirty (57.7%) of them were males and the majority (77%) of the participants were fifty years old or younger. The mean age was 43.8 (± 14). The majority (86.5%) of the participants were from a rural area. Thirty-eight (73%) patients take alcohol occasionally while 11(21.2%) patients take alcohol frequently or massively. Eight (15.4%) patients reported a history of multiple sexual partners. Herbal medicine use was reported by 28 patients (53.8%). Only 5 (9.6%) patients were overweight. Chronic liver disease (CLD) was the major cause of ascites in this study in 24 (46.2%) patients. The other main causes of ascites were heart failure from various causes (19.2%), tuberculosis and hepatosplenic schistosomiasis contributing to 11.5% each and chronic kidney disease (5.8%). Five (20.8%) CLD patients had spontaneous bacterial peritonitis as a complication. Five (20.8%) and 4 (16.7%) CLD patients had hepatocellular carcinoma and hepatic encephalopathy as complications, respectively. Nine (17.3%) patients had variceal bleeding; six of the patients were diagnosed to have CLD while the remaining patients were having hepatosplenic schistosomiasis. Conclusion: In conclusion, liver cirrhosis is the major cause of ascites in Gondar, Ethiopia, while chronic viral hepatitis infections (hepatitis B (HBV) and C (HCV) viruses) are the main causes of liver cirrhosis. The other major causes included heart failure, tuberculosis, and hepatosplenic schistosomiasis. It is wise to consider and give priority to these diseases whenever one is evaluating a patient with ascites.

Evaluation and treatment of malignant ascites secondary to gastric cancer.

Malignant ascites affects approximately 10% of patients with gastric cancer (GC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in GC patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points (named "five-point method") on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, "Clinical Benefit Response in GC (CBR-GC)", was recently introduced to measure the efficacy of chemotherapy for malignant ascites of GC. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for GC patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a standard treatment based on the available guidelines, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), laparoscopic HIPEC alone, intravenous chemotherapy, intraperitoneal chemotherapy, and molecular targeting therapy. Although each treatment option is valid, further research is imperative to establish the optimal choice for each patient.

The effects of turmeric supplementation on antioxidant status, blood gas indices and mortality in broiler chickens with T(3)-induced ascites.

1. A total of 320 one-day-old Ross male broiler chickens were used to investigate the effects of 0·0, 2·5, 5·0 and 7·5 g/kg turmeric rhizome powder (TRP) in the diet, on antioxidant status, biochemical gas indices and mortality in broiler chickens with triiodothyronine (T(3)) induced ascites. 2. The TRP supplementation had no effect on blood pH, pO(2) or pCO(2) during the whole period of study. Moreover, supplementation of TRP did not influence the heart weight, right ventricle, left ventricle, or total ventricle weights, all relative to total live weight; RV/TV (right ventricle to total ventricle) ratio; or serum GPX (glutathione peroxidase) or SOD (superoxide dismutase) activities at week 6. 3. TRP supplementation influenced the blood [Formula: see text] and O(2) saturation during the whole period of study, total mortality due to ascites, and serum total tocopherol and malondialdehyde (MDA) contents. Blood [Formula: see text] and serum total tocopherol increased linearly as dietary TRP level increased. Blood O(2) saturation increased quadratically as dietary TRP increased. 4. Total ascites mortality and serum MDA content decreased linearly with increasing TRP level to 5 mg/kg and then reached a plateau. 5. The results of the study indicate that the addition of 5·0 g/kg TRP is sufficient to increase the blood O(2) saturation and bicarbonate ([Formula: see text]) concentration, and reduce the mortality due to ascites and serum MDA content.

Growth, carcass characteristics, and incidence of ascites in broilers exposed to environmental fluctuations and oiled litter.

The effects of diurnal temperature fluctuations and removal of respirable dust, by application of canola oil to straw litter, on growth, carcass traits, and the degree of ascites was evaluated with 1,200 male broilers studied in two replicated 6-wk trials. Each trial used four pens of 150 birds. The temperature treatment consisted of a fluctuation of 3 C in temperature above the required temperature during the day (0600 to 1800 h) and 3 C below the required temperature at night (1800 to 0600 h) for a 6 C change in daily temperature. The control temperature was constant. All pens had the same mean daily temperature. In each trial, one control temperature pen and one fluctuation temperature pen received bi-weekly applications of canola oil to the litter (1.1 L/m2 of oil over 6 wk). At 6 wk of age, 30 birds from each pen were killed for determination of breast muscle, fatpad, and heart weights. All birds were scored for lesions of ascites at time of processing. A score of 0 or 1 represented slight pericardial effusion, slight pulmonary congestion, and edema. A score of 4 represented birds with marked accumulation of ascitic fluid in one or more ceolomic cavities (other than the pericardium) and advanced liver lesions. A cross-sectional image of each 4-mm heart slice (cross-section of the ventricles) was digitally recorded, and with image analysis we determined the right ventricular area (RVA), left ventricular area (LVA), and total heart area (HA). The final BW of the broilers were significantly different, the oiled-litter treatment (2,249 g) had lower weight gain compared with the nonoiled litter treatment (2,293 g). There were no differences in fatpad weight, shank length, lung weight, and percentage breast muscle between the main treatments. The Pectoralis minor and Pectoralis major weight were significantly heavier in the temperature fluctuation treatment than in the control temperature treatment by 3.0 and 12.0 g, respectively. The birds subjected to the control temperature treatment had a lower RVW than the birds subjected to the fluctuating temperature treatment. Temperature fluctuations also resulted in a 1.4% increase in the incidence of mortality. Temperature fluctuations negatively impact broiler growth due to heat loss when litter oiling was excessive.

Effect of dietary flax oil and hypobaric hypoxia on right ventricular hypertrophy and ascites in broiler chickens.

1. The effect of dietary flax oil on growth rate, blood haemoglobin content, mortality and incidence of pulmonary hypertension and ascites in broilers at ambient pressure and at reduced atmospheric pressure was examined. 2. Birds were housed either in hypobaric chambers simulating 1000, 1500 or 2200 m altitude or in pens at ambient atmospheric pressure and fed on diets containing 100 g/kg added fat as either an animal/vegetable (A/V) blend or flax oil. 3. Birds raised under hypobaric conditions had a decreased growth rate and increased mortality, blood haemoglobin content, and incidence of pulmonary hypertension and ascites compared to the groups at normal atmospheric pressure. 4. Broilers fed on the diet containing flax oil showed no difference in growth rate or blood haemoglobin content compared to birds fed on the A/V fat diet raised at the same altitude. 5. Inclusion of flax oil in the diet decreased mortality and the incidence of ascites at 2200 m and pulmonary hypertension at 1500 m. 6. Flax oil may be an effective method of reducing ascites and pulmonary hypertension in broilers without affecting performance.

Does pulmonary hypertension syndrome (ascites) occur more frequently in broilers medicated with monensin?

The performance of broilers reared in floor pens and given monensin in the feed at 121 ppm was compared with that of birds given no drug. Feed intake and BW gain of medicated birds was significantly lower than that of unmedicated birds from 0 to 22 d of age. Feed intake and feed conversion of medicated birds was significantly reduced, compared with unmedicated birds, from 22 to 53 and 0 to 60 d of age. Total mortality, and mortality due to leg abnormalities from 22 to 53 and 0 to 60 d, was significantly lower in birds given monensin. There was no difference in the incidence of tibial dyschondroplasia (TD) by 60 d. No differences in mortality due to pulmonary hypertension syndrome (PHS) were observed for any age period. Birds removed from pens at 28 d that had received monensin had lower hematocrit and percentage saturation of hemoglobin with oxygen in the blood than unmedicated birds. No differences in these variables were found at 54 d. There were no differences in the right ventricle weight: total ventricular weight ratios or electrocardiogram lead II values at 28 or 54 d. The results indicate that PHS does not occur more frequently in broilers medicated with monensin.

Effect of a urease inhibitor and ceiling fans on ascites in broilers. 1. Environmental variability and incidence of ascites.

A low ventilation model to induce ascites was introduced and characterized. In addition, the effect of supplemental air mixing via ceiling fans (CF) and the feeding of a urease inhibitor (0, 125, and 250 ppm) on incidence of ascites were investigated. Twelve environmental chambers were utilized in the trial; six were fitted with CF. Each dietary treatment was replicated twice per CF treatment. One hundred and twenty day-old male commercial broilers were reared per chamber. Atmospheric O2, CO2, and NH3, temperature, and humidity, as well as weekly litter moisture and pH, were monitored. Chamber CO2 levels increased immediately then stabilized. Chamber NH3 levels increased between 2 to 4 wk of age and rapidly declined when ventilation rates were increased to 1 cfm per bird. The CF and dietary treatments had little effect on air or litter variables except for NH3. Supplementing the diet with urease inhibitor resulted in a greater than 50% reduction in cumulative mortality due to ascites and a slight reduction in weekly BW gains. The CF treatment had no effect on production variables such as weekly feed intake, gain, and feed to gain ratio, or survivability due to ascites.