ABSTRACT
Background: Hepatitis C and chronic kidney disease (CKD) both present an unsolved public health problem Hepatitis C virus (HCV) is easily transmitted in haemodialysis units and by kidney transplantation. HCV leads to increased mortality and morbidity due to cirrhosis and hepatocellular carcinoma, while accelerating the progression of CKD. The aim of the study was to describe the demographic, clinical/biochemical profile and prevalence of patients with CKD who have HCV infection.Methods: This was a retrospective analysis of patients with CKD who presented to out/in patient department of medicine in a tertiary care center in Jammu from a period of Feb 2016 to Nov 2018. Detailed clinical history along with previous lab reports were noted and tests for HCV infection were conducted in all patients. Diagnosis of HCV was made via HCV RNA(RT PCR) and positive Anti HCV IgG serology.Results: Total 67 patients were included with median age of 54 years (range 43-72 years) with majority 76.1% being males, and 71.6% within 41-60 years age group. 31.4% were HCV positive out of which 81% were males. 7 patients were found to have co-infection with HIV and HBsAg. Genotype 1 (72%) was found to be more common than Genotype 3. Ultrasonography and Upper GI endoscopy showcased 57% with dilated spleenoportal axis and oesophageal varices respectively.Conclusions: Prevalence of HCV infection in CKD patients is high with genotype 1 being commonest. False negative Anti HCV antibody is common hence screening with HCV RNA is recommended. Strict universal precautions should be employed in hospitals and dialysis units to prevent transmission.
ABSTRACT
Upper gastrointestinal (UGI) endoscopy is an important diagnostic modality in evaluation of patients with upper gastrointestinal (GI) disorders. However, lesions located in the cricopharyngeal area and upper esophagus can be missed, as this area may not be well visualized during endoscopy. This study was conducted to study the utility of a new technique of endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire in diagnosing esophageal disorders. Patients with suspected upper esophageal disorders on history and radiological investigations were assessed using guide wire assisted endoscopic examination during withdrawal of the endoscope. In this technique, endoscope is inserted into the esophagus under vision and thereafter the whole of esophagus, stomach and proximal duodenum is examined. The endoscope is then withdrawn into the mid-esophagus, a guide wire is fed into the biopsy channel, and thereafter inserted into the esophagus. Once guide wire has been advanced into the esophagus, the endoscope is withdrawn gently over the guide wire into esophagus carefully examining for lesions in upper esophagus and cricopharyngeal area. Twenty cases of various abnormalities localized to the upper esophagus were studied. The final diagnosis in these patients was cervical esophageal web (10), post transhiatal esophagectomy leak (4), heterotopic gastric mucosa (3), posttraumatic esophageal perforation (2), and Zenker's diverticulum (1). Intact web was detected in 2 patients and in 8 patients fractured web was seen. Guide wire assisted examination of upper esophagus improved the ability to visualize and characterize these lesions and no complications were encountered as a result of this procedure. Endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire is safe and effective in diagnosing anatomical abnormalities of the upper esophagus that may be missed or poorly characterized during standard endoscopy.