Secondary gastric varices in hepatic cirrhosis

To determine the frequency of secondary gastric varices after esophageal variceal eradication in patients with cirrhosis of liver and factors associated with their development. Observational study. The Department of Gastroenterology, Liaquat University Hospital, Jamshoro and Isra University Hospital Hyderabad, from September 2007 to July 2009. Consecutive patients with decompensated cirrhosis of liver were subjected to endoscopy for management of varices. Endoscopic variceal band ligation was done in all patients. Secondary gastric varices were noted at surveillance. Receiver-operating characteristic [ROC] curves were used to determine the cut off values of secondary gastric varices and various factors influencing the development of gastric varices after eradication with the best sensitivity and specificity. Of the 162 patients; 46 [28.3%] were females and 116 [71.7%] males. The mean age was 45 +/- 13 years. Fundal varices were present before eradication in 12 [7.4%] patients and after eradication of varices in 38 [23.5%] patients. A strong association was found between gastric varices after eradication and Child Pugh class [p=0.001], grade of varices at the time of presentation [p=0.024], increasing number of sessions for eradication of esophageal varices [p=0.001] and presence of gastric varix at the time of first presentation [p=0.009]. Secondary gastric varices are common in cirrhosis. A significant association with Child-Pugh class, presenting grade, increasing number of ligation session and prior existence was seen in the studied group

Self expandable metallic stent endoscopic insertion in esophageal cancer

To determine the safety of self expandable metallic stent [SEMS] placement under endoscopic guidance without fluoroscopy. Quasi experimental study. Section of Gastroenterology and Hepatology, Departments of Medicine, Isra University Hospital and Liaquat University of Medical and Health Sciences [LUMHS], Hyderabad, from April 2006 to March 2009. In 80 patients with inoperable carcinoma of esophagus, SEMS made-up of nickel titanium alloy and mesh shaped with distal release system were placed without the use of fluoroscope under endoscopic guidance. Patients with proximal location of tumour in esophagus were excluded. They were followed at one week after deployment. All the complications were recorded. Dysphagia score was assessed before and after stent placement. Mean pre- and poststenting scores were compared using t-test. Fluoroscopy was needed in only 2 patients. In 75 patients the stent was successfully placed with endoscope control only, without fluoroscope. Dysphagia score improved significantly from 4.26 +/- 1.07 before stenting to 1.02 +/- 0.57 later, [p < 0.001]. Minor complications like retrosternal pain occurred in 30 [37.5%] patients and major complications in 8 [10.0%] patients amongst which 4 [5.0%] developed upper gastrointestinal bleeding and 4 patients [5.0%] had aspiration. Insertion of self expandable metallic stent in esophageal carcinoma without fluoroscope was safe and effective in relieving dysphagia at short term follow-up

Validation of three non-invasive markers in assessing the severity of liver fibrosis in chronic Hepatitis C

To compare various biochemical markers i.e. APRI [AST to platelet ratio index], aspartate aminotransferase [AST] alanine aminotransferase [ALT] ratio, FIB-4 [AST, platelet, AST and age] with biopsy for assessing the severity of hepatic fibrosis in patients with hepatitis C. Study Design: Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2005 to March 2007. Consecutive hepatitis C virus RNA positive and previously untreated patients were studied. Liver biopsy with histological evaluation and AST/ALT ratio, AST to platelet ratio index and FIB-4 were assessed in all patients. Receiver operative curves were developed. There were 158 patients [109 males, 49 females]. On histological grounds non-advanced fibrosis [F0-1] was present in 74 [46.5%] of cases, whereas 84 [53.5%] patients had advanced [F2-4] fibrosis. The area under the receiver operating characteristic curves of APRI < 0.05-1 and FIB-4 < 1.45 were 0.7 and 0.74 respectively, which means that APRI < 1 and FIB-4 < 1.45 will exclude advanced fibrosis in 70% and 74% of patients respectively. An APRI of > 1 and FIB-4 will predict advanced fibrosis in 87% and 98% of patients respectively. AST/ALT ratio was inferior to both of these biomarkers. Both APRI and FIB-4 not only exclude minimal fibrosis but can predict advanced fibrosis in the majority of the patients. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy

Serum zinc and magnesium in Type-2 Diabetic Patients

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. Non-interventional case control study. Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, from October 2007 to March 2008. 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. 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]. 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