الفهرس | Only 14 pages are availabe for public view |
Abstract Budd–Chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at the level of the hepatic venules, the large hepatic veins, the inferior vena cava till its junction with the right atrium (Valla, 2008). The classic triad of abdominal pain, ascites, and hepatomegaly is observed in the vast majority of patients with Budd-Chiari syndrome, but it is nonspecific (Goel et al., 2015). Warfarin was introduced into clinical practice in the 1950s, and has been the most widely prescribed oral anticoagulant for prevention and treatment of thrombotic diseases despite its significant side effects as (bleeding tendency, drug drug interaction). Vitamin K epoxide reductase complex subunit1 (VKORC1), a membrane protein located in hepatocytes, has an important role in the anabolism of vitamin K, which is essential for blood coagulation All included patients were subjected to: History taking, full clinical examination, throbmpophilia work up [Fvlm-MTHFR-factor 2-anti thrombin 3-protein c/sCD55/CD59-jak2-ANA with titre-anti DNA-lupus anticoagulant-anticardiolipin igG/igM-viral markers] Screening to be under warfarin therapy as the single anticoagulant therapy with maximum dose (10ml) Mutation detection for VKORC1 was performed for all enrolled subjects regarding the issue that the pharmacodynamic mechanism of warfarin resistance relied on or VKORC1 polymorphism PT, PTT and INR were used to monitor effectiveness of warfarine every 3 days. The PT and PTT was be determined using standard Kits according to the manufacturer‘s instruction. All procedures were be approved by an Ethics Committee (El demerdash hospital Ain hams university, and participants’consent was be obtained. 2.AIM/ OBJECTIVES This study was designed to evaluate effect of the allelic frequency of the VKORC1 (G1639A) polymorphic genes by real time PCR on response of Egyptian patients with Budd– Chiari syndrome or PVT to Warfarin. Methodology: Patients and Methods Type of Study: A cross sectional study. Study Setting: Budd chiarri study group clinic..tropical medicine department in Ain shams university hospitals Study Period: 6 months. Study Populationo Inclusion Criteria: Egyptian Patients diagnosed with Budd–Chiari syndrome and/or benign portal vein thrombosis. Including males and females above 18 years old till 60 years old. o Exclusion Criteria: All patients not on vitamin k antagonist oral long acting anticoagulant (all patients not on warfarine) -patients below 18 years old and above 55years old-patients wih malignant portal vein thrombosis. Sampling Method: We will include 50 cases with budd chiarri syndrome and/ or benign P.V.T. presenting in Budd chiarri study group clinic. tropical medicine department in ain shams university hospitals. Sample Size: 50 patients [Budd–Chiari and/or benign P.V.T.]. Study Procedures: All patients will be subjected to the following: History taking, full clinical examination, throbmpophilia work up[Fvlm-MTHFR-factor 2-anti thrombin 3-protein c/s-CD55/CD59-jak2-ANA with titreanti DNA-lupus anticoagulant-anticardiolipin igG/igM-viral markers]. o Screening to be under warfarin therapy as the single anticoagulant therapy with maximum dose (10ml) Mutation detection for VKORC1 will be performed for all enrolled subjects regarding the issue that the pharmacodynamic mechanism of warfarin resistance relies on or VKORC1 polymorphism. o PT, PTT and INR are used to monitor effectiveness of warfarine every 3 days. o The PT and PTT will be determined using standard Kits according to the manufacturer‘s instruction. o All procedures will be approved by an Ethics Committee (El demerdash hospital Ain Shams University, and participants’consent will be obtained. |