Introduction: Liver is the main organ in the metabolic process of carbohydrates. Alterations in carbohydrates metabolism and diabetes mellitus (DM) are common in cirrhotic patients. For instance, resistance to insulin is an important prognostic factor in liver CIRRHOSIS. The aim of this study is to determine the incidence of diabetes and its effective factors in CIRRHOSIS patients, as compared to the normal group. Materials and Methods: This case-control study was conducted on 100 patients with CIRRHOSIS who were admitted to Aria, Bahman 2nd and Shahrivar 17th Hospitals. The subjects were selected through simple random sampling. Based on the criteria adopted for this study, the patients were qualified to enroll in the study. Checklists were completed for the patients. The presence of DM on the part of the subjects was diagnosed either by having a history of DM and the use of anti-diabetic drugs such as glybenclamid and insulin, or FBS ³ 126 mg/dL at two times. Data analysis was performed using Pearson Chi-square and Fisher exact test.Results: Out of all patients 37 were females and 63 were males (Mean age 63.57 years). Prevalence of DM and IFG in these patients were much more than normal population (P<0.05). There were significant statistically relationship between sex (F>M) and age>60 years in diabetes and CIRRHOSIS patients in compare with normal group (P<0.05). Family history of DM and severity of CIRRHOSIS were also associated with DM (P<0.05). Among complications of CIRRHOSIS, prevalence of DM was more in patients with encephalopathy and ascites.Conclusion: In this study, our findings indicate that cirrhotic patients are at the increased risk of DM occurrence. Female sex, age>60 years, family history of DM, severity of liver disease and presence of encephalopathy and ascites were associated with DM occurrence in these patients. The Regular screening for DM can be useful for early diagnosis and treatment of these patients.

Introduction: Decompensated CIRRHOSIS resulting from chronic hepatitis B causes a significant decrease in survival of these patients. Prescription of Alpha interferon for these patients is forbidden. Several studies have shown the effectiveness of Lamivudine in decreasing the Symptoms arising from this decompensation. Objective: The aim of this study is to determine the effect of Lamivudine on liver function and clinical status of the patients with decompensated CIRRHOSIS arising from HBV presenting to the Supporting Center of patients with liver diseases or those being hospitalized at Gastrology Department of Imam Khomeini Hospital.Materials and methods: In a clinical trial on the basis of liver consideration in 55 patients with CIRRHOSIS that had positive HbsAg, positive HBV DNA, child-pugh score more than 8, but not with positive HCV Ab or positive HIV Ab and creatinin of serum, more than 2 mg/dl, they were treated with 100 mg of Lamivudine tablets daily.In these patients, serum level of bilirubin, albumin, ALT, AST and also the PT coagulation time (on the basis of INR) were controlled at the beginning of study and then at intervals of 2 to 6 months and finally 12 months after the start of treatment and in terms of presence and intensity of ascites and encephalopathy, the patients were examined by a physician. Also at the beginning of the study and 6 and 12 months later, HBs, Ag, HBV DNA, Hbe Ag and Hbe Ab were checked. On the basis of the table related to child-pugh, its amount was calculated at the beginning of the study and at intervals of 2 to 6 months and then 12 months.Results: 5 patients died in the first 6 months of treatments. The following results are related to 50 patients being under treatment with Lamivudine at least for a period of 6 months. In these patients mean child-pugh score was decreased from 11±2 (mean ± criterion deviation) to 7±1 (p<.0001), mean level of bilirubin from 4.5±2 to 1.3±1.6 mg/dl (p<.0001) and mean level of albumin from 2.6±2 to 3.8±1.3 g/dl (p<.0001) and mean PT (INR) from 1.7±2 to 1.2±2 (p<.0001) and mean ALT from 98±10 to 32±10 units per liter (p<.0001). Out of 19 patients not being precormutant, 4 patients (22%) had Hbe Ag seroconversion after 6 months of treatments and 5 (26%) after a 12-month treatment with Lamivudine. All of the patients tolerated this drug very well.Conclusion: Lamivudine can be effective in improvement of liver function in patients with decompensated liver CIRRHOSIS resulting from HBV, but for determination of proper period of treatment, further studies are necessary.

An analysis of cohorts of patients with compensated CIRRHOSIS caused by the Hepatitis B Virus (HBV) indicates that the disease decompensates at an annual rate of 1.5% to 5%. Following decompensation, the 5-year survival rate has varied from 14% to 35%. the 5-year survival rate in untreated patients is higher in patients decompensating from variceal bleeding than in those decompensating from ascites (29vs.16%).

Background: Advanced hepatic fibrosis and CIRRHOSIS has generally been considered to be irreversible. The aim of this study was to determine whether CIRRHOSIS is reversible.Methods: Seven patients with autoimmune hepatitis with histologic evidence of CIRRHOSIS were enrolled. After treatment, they had follow-up liver biopsy while in clinical and biochemical remission. Biopsy specimens were randomly coded in unpaired manner according to patient and were read independently by two pathologists using the modified hepatitis activity index (with a maximum stage of 6).Results: Three patients still had extensive fibrosis in the second liver biopsy. But four patients had almost total regression of their liver fibrosis. In the latter patients, the mean alanine aminotransferase level decreased from 776.3 U/L to 23 U/L. The mean bilirubin level decreased from 5.85 mg/dL, to 0.98 mg/dL. Extensive fibrosis or CIRRHOSIS were present in all patients at diagnosis but were not present on follow-up liver biopsy. The mean fibrosis score decreased from 5.88 to 0.5 (P=0.0002), and the mean grading score from 11.38 to 2.5 (P=0.0008.).Conclusion: Frank CIRRHOSIS due to autoimmune hepatitis may be reversible in some patients who respond to treatment.

The coexistence of Waldenstrom's macrglobulinemia and cryptogenic CIRRHOSIS has been rarely reported. We describe a 72-year-old man with compensated cryptogenic CIRRHOSIS whose major clinical presentation was hyperviscosity syndrome.Serum protein electrophoresis revealed the presence of an IgM-kappa spike. Lambda light chain was found in urine. Bone marrow biopsy was performed, which showed at least 22% infiltration with atypical plasma cells. No bone lesion was found. ByWaldenstrom's macroglobulinemia diagnosis, patient treated with melphalan, thalidomide and dexamethasone. After three weeks of treatment, his symptoms disappeared and serum immunoglobulineM decreased below 1000mg/dl.

CIRRHOSIS is characterized by marked abnormalities in the cardiovascular system. A hyperdynamic splanchnic and systemic circulation is typical of cirrhotic patients and has been observed in all experimental forms of portal hypertension. The hyperdynamic circulation is most likely initiated by arterial vasodilatation, leading to central hypovolemia, sodium retention, and an increased intravascular volume. Despite the baseline increase in cardiac output, ventricular inotropic and chronotropic responses to stimuli are blunted, a condition known as cirrhotic cardiomyopathy. This review briefly examines the major mechanisms that may underlie these cardiovascular abnormalities, concentrating on nitric oxide, endocannabinoids, prostaglandins, carbon monoxide, endogenous opioids, and adrenergic receptor changes. Future work should address the complex interrelationships between these systems.

Background: Bone loss is common in CIRRHOSIS. However, the prevalence of osteopenia and osteoporosis has been heterogeneous in different reports. Reduction in bone formation with or without increase in bone resorption appears to be responsible for bone loss in these patients.Objectives: We aimed to investigate bone loss in patients with CIRRHOSIS at different anatomical sites and key factors that might affect it.Patients and Methods: In this cross-sectional study, 97 patients with CIRRHOSIS who were referred to Razi Hospital, Rasht, Iran, from 2008 to 2010, were studied. CIRRHOSIS was diagnosed using biopsy and/or clinical and paraclinical findings. Bone mineral densitometry was done in L2 through L4 lumbar spine (LS) and femoral neck (FN), using dual-energy X-ray absorptiometry (DEXA) (QDR 1000, Hologic DEXA Inc, Waltham, Massachusetts, the United States). Statistical analysis was performed using SPSS 18. A P value < 0.05 was considered statistically significant.Results: A total of 97 patients with CIRRHOSIS (55.7% male) and the mean age of 51 ± 13 years and median body mass index (BMI) of 22.7 kg/m2 were recruited over a two-year period. Etiologies of CIRRHOSIS were hepatitis C (40.2%), hepatitis B (26.8%), cryptogenic (21.6%), and other causes (11.4%). Child A, B, and C, were seen in 16.5%, 47.4%, and 36.1% of patients, respectively. The DEXA results were abnormal in 78.4% of our participants (osteopenia, 45.4%; osteoporosis, 33%). BMI and calculated glomerular filtration rate (GFRc) had moderate positive and Child score had moderate negative significant correlation with T score in both anatomical sites. There was no significant association between abnormal DEXA and the causes of CIRRHOSIS. The univariate analysis showed that the risk of abnormal results in DEXA was significantly higher in those with low BMI, current smoking, higher Child score, and low GFRc; however, in multivariate analysis, the abnormal results were more frequent in those with lower vitamin D, higher Child score, and less GFRc.Conclusions: Abnormal DEXA was highly prevalent among patients with CIRRHOSIS. The risk of this finding was increased by lower vitamin D levels, advanced disease, and impaired renal function.