Coagulation abnormalities in patients with chronic liver disease in Pakistan.

OBJECTIVE: To determine the coagulation abnormalities and relationship between abnormal clotting tests and the risk of gastrointestinal bleeding (GI) among chronic liver disease (CLD) patients admitted at a tertiary care hospital in Pakistan. METHODS: Adult CLD patients admitted at Liaquat University Hospital Jamshoro, during Nov 2004-Oct 2005, were included in the study. The patients blood were tested for coagulation abnormalities including prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count and plasma fibrinogen. Association was seen between the abnormal clotting tests and the gastrointestinal bleeding by calculating relative risk (RR) with 95% confidence interval. RESULTS: PT was prolonged in 88% and aPTT was raised in 71% cases of CLD. Both PT and aPTT were prolonged in 67% CLD cases. Approximately 37% CLD cases had decreased platelet count and 15% cases had decreased serum fibrinogen level. Relative risk of GI bleeding with abnormal clotting tests in CLD cases were weakly positive for PT (RR = 1.02; 95% CI, 0.49-2.10), negative for aPTT (RR = 0.83; 95% CI, 0.47-1.45), strongly positive for decreased platelet counts (RR = 1.96; 95% CI, 1.08-3.56) and also for decreased fibrinogen level (RR = 1.47; 95% CI, 0.64-3.35). CONCLUSION: Coagulation abnormalities were profound in CLD. Decrease platelet counts and fibrinogen levels were related with GI bleeding but PT and aPTT were not significantly related with GI bleeding in patients with chronic liver disease. Nevertheless, these parameters (PT and aPTT) were still used as prognostic markers.

Serum zinc and magnesium in type-2 diabetic patients.

OBJECTIVE: To assess serum zinc and magnesium level in type-2 diabetic patients and the effect of age, gender, glycemic control and duration of diabetes on these trace elements in comparison with those of control subjects. STUDY DESIGN: Non-interventional case control study. PLACE AND DURATION OF STUDY: Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, from October 2007 to March 2008. METHODOLOGY: There were 42 diabetic patients and 42 age matched non-diabetic (control) subjects included in this study. Serum zinc, serum magnesium and fasting blood sugar measured among the diabetic and control groups and association of both trace elements were assessed with glycemic status, age, gender and duration of diabetes using SPSS version 16.0 for analysis. RESULTS: Serum zinc level was significantly lower (mean 2.03 +/- 0.39 mg/dL) in diabetic patients as compared to control subjects (4.84 +/- 4.217 mg/dL, p = < 0.001). No significant difference was found in serum magnesium level with mean of 22.67 +/- 24.5 mg/dL in diabetic patients as compared to controls (18.3 +/- 3.4 mg/dL, p = 0.26). CONCLUSION: Serum zinc level was significantly lower in type-2 diabetics, whereas no significant difference was found in serum magnesium level when compared with control subjects. There was no association of age, gender, glycemic status and duration of diabetes on the serum concentration of these trace elements in type-2 diabetic patients.