Role of intravenous naloxone in severe pruritus of acute cholestasis

Pruritus is a well-known manifestation of various cholestatic disorders. Increased opioidergic tone is one of the mechanisms for this. This prospective, uncontrolled study was done to determine the efficacy of intravenous naloxone in pruritus of acute cholestasis. Twenty-two patients with severe pruritus (based on visual analogue scale [VAS] score of 0-100 and associated symptoms) were treated with intravenous naloxone (0.4 mg every 8 hours) for at least 48 hours. Viral hepatitis E was found to be the most common etiology for cholestatic pruritus (n=12). Eighteen patients (81.8%) patients had significant reduction in VAS after 48 hours of starting naloxone; these patients also showed reduction in alkaline phosphatase and gamma glutamyl transpeptidase. There was no side-effect or 'breakthrough' phenomenon noted in any patient over next 6 weeks. Naloxone is safe and efficacious in symptomatic improvement in cholestatic pruritus.

Serum interleukin 8 and 12 levels predict severity and mortality in patients with alcoholic hepatitis

BACKGROUND

Alcoholic hepatitis (AH) is a common life-threatening illness particularly when it is severe. Alcoholic liver disease is associated with cytokine imbalance. There is paucity of information about the relationship of interleukin (IL) levels with severity and mortality of patients with AH. Our aim was to correlate serum IL-8 and IL-12 values with disease severity (mild vs. severe) and mortality.

METHODS

Fifty patients and 25 healthy subjects were included in the study. Serum IL-8 and -12 levels were analyzed and correlated with disease severity and mortality. Predictive value for 6 months mortality of IL-8, IL-12, Maddreys discriminant function (mDF), age, bilirubin, international normalized ratio, and creatinine score (ABIC) and Glasgow alcoholic hepatitis score (GAHS) was compared by the area under the receiver operating curve (AUROC).

RESULTS

Mean (±SD) serum IL-8 levels were significantly higher in patients with severe AH as compared to mild AH [539.04 ± 89.77 vs. 253.66 ± 56.66 pg/mL (p < 0.001)] and controls [539.04 ± 89.77 vs. 99.96 ± 20.94 pg/mL (p < 0.001)]. Similarly, mean (+SD) serum IL-12 levels in severe AH were also significantly higher as compared to mild AH [344.47 ± 93.04 vs. 101.92 ± 16.70 pg/mL (p < 0.001)] and controls [344.47 ± 93.04 vs. 47.84 ± 11.22 pg/mL (p < 0.001)]. AUROCs of IL-8, IL-12, mDF, ABIC, and GAHS were 0.995, 0.998, 0.975, 0.873, and 0.883 for predicting 6 months mortality.

CONCLUSION

Serum IL-8 and -12 levels were markedly elevated in AH with increasing levels as the severity increases. Serum levels of IL-8 and -12 were better predictors of short-term mortality as compared to conventional prognostic scores.

Ankle brachial index as a predictor of generalized atherosclerosis

OBJECTIVE

To assess ankle brachial index (ABI) as a screening method to target subclinical atherosclerosis in middle aged individuals.

MATERIAL AND METHODS

Total 160 patients over the age of 40 years were included in the study for a period of 16 months. Their ABI was determined either by colour Doppler method (30 patients) and/or sphygmomanometry (all 160 patients). A value of < 0.9 was taken as cutoff point for significant stenosis.

RESULTS

Total 69 patients out of total of 160 had significantly low ABI value (43.12%) which shows that there is a very high incidence of low ABI in the community. Overall > 50% of the patients were largely asymptomatic and had presence of two or more risk factors. ABI < 0.9 was a good screening test to detect such individuals at an earlier stage (sub-clinical).

CONCLUSION

A significantly low (< 0.9) ABI value can detect subclinical atherosclerotic vascular involvement and predict future occurrence of preventable major vascular event.

Hepatic granuloma in chronic hepatitis C

We report the findings in a 54-year-old male with chronic hepatitis C with granulomas liver biopsy. Unfortunately, this patient died before treatment could be started.