Frequency of asymptomatic spontaneous bacterial peritonitis in outdoor patients with liver cirrhosis

The objective of this study was to the incidence of silent SBP in asymptomatic cirrhotic patients of Military Hospital out patient department. Prospective study. Gastroenterology Department, Military Hospital Rawalpindi from July 2013 to Dec 2013. Prospective exploration for evidence of SBP in asymptomatic cirrhotic patients due to any etiology with ascites. Clinical and laboratory features of consumptive outpatients with cirrhotic ascites undergoing paracentesis were recorded between July 2013 and December 2013 and ascetic fluid analysis was carried out. The frequency of spontaneous bacterial peritonitis in the population of 80 cirrhotic outpatients as determined by neutrocytic ascites [absolute neutrophil count >250 cells/mm] was 10%. Of the 8 patients with neutrocytic ascites, none was culture positive. The patients with absolute neutrophiI count > 250 cells/mm were treated with antibiotics for seven days. Repeat diagnostic paracentesis showed marked improvement in absolute neutrophilic count. None of the patients developed hepatorenal syndrome or hepatic encephalopathy or recurrent SBP during 3 months follow up. Incidence of silent SBP in asymptomatic cirrhotic patients' cases is significantly high. Antibiotic treatment in these patients ensures no further complications. However, a population may be studied to know the exact prevalence of silent SBP in our country

HCV transmission between serodiscordant couples through sexual route

To determine the rate of transmission of HCV between spouses through sexual route. Descriptive study. This study was carried out at Military Hospital, Rawalpindi, Pakistan. It was conducted over a period of 4 years from June 2009 to June 2013. One hundred and sixty eight consecutive patients confirmed to have HCV infection by PCR for HCV RNA were enrolled in the study. Their spouses were also included in the study, and it was established through PCR for HCV RNA that the spouses were not suffering from HCV infection. All couples were inducted in the study within the first two months of starting the study. Therefore, the maximum and minimum follow-up time was 48 months and 46 months, respectively. The spouses were questioned for HCV risk factors and were tested for HCV antibodies six monthly. Once spouses were found to be anti-HCV positive, their HCV status was confirmed with PCR for HCV RNA. Out of 168 patients, 90 [53.57%] were males and 78 [46.43%] were females. PCR for HCV RNA was found to be positive in 4 of 168 [2.38%] spouses. All these 4 couples in whom HCV transmission was found had genotype 3a. Out of the 4 spouses who tested positive for HCV RNA PCR, 3 [75%] were females and 1 [25%] was male. So HCV infection was transmitted in 3 out of 90 [3.33%] and 1 out of 78 [1.28%] female and male spouses, respectively. In PCR for HCV RNA positive and negative spouses, the duration of marriage was 202 +/- 53 and 199 +/- 49 weeks; and the number of total sexual intercourses was 171 +/- 93 and 169 +/- 89, respectively. HCV transmission among serodiscordant couples in our setup did occur. The overall rate of transmission was 2.38%. The rate of transmission from male to female [3.33%] was higher than female to male [1.28%]. However, a large scale study conducted over a longer duration of time is needed to recommend protected sex in serodiscordant couples if either partner is suffering from HCV infection

End of treatment response in chronic hepatitis C patients treated with interferon alpha and ribavirin

We conducted a study at Combined Military Hospital [CMH], Sialkot, from August 2010 to February 2011 with the objective to determine the frequency of early and end of treatment virological response in patients with chronic hepatitis C infection treated with IFN-alpha / ribavirin therapy. HCV RNA PCR positive adult patients of either gender were included in the study. A total of 123 patients [56 males and 67 females] were given alpha-interferon ribavirin for 24 weeks. At 12 weeks post-treatment, 82 patients out of 123 [EVR 66.6%] had negative HCV RNA PCR while 85 patients out of 123 were HCV PCR negative at 24 weeks [ETR 69.1%]. Conventional alpha-interferon ribavirin therapy should discontinued in patients who are non responders at 12 weeks of treatment and be offered pegylated interferon to save time, money and minimize the side effects

Endoscopic ultrasound guided biopsy of a mediastinal mass

Endoscopic ultrasound [EUS] now has an established role in the diagnosis, staging and management of cancers of the oesophagus, stomach, pancreato-biliary system and rectum. Recently, a role for EUS in the staging of lung cancers has been proposed. Linear EUS allows fine needle aspiration [FNA], core biopsies and therapeutic manoeuvres such as coeliac plexus block to be performed. We present here the first reported EUS-guided biopsy from Pakistan. A patient with probable bronchogenic carcinoma was referred for assessment of operability. A thoracic CT scan showed subcarinal and aorto-pulmonary recess lymphadenopathy. An EUS-guided FNA was performed, confirming metastatic non-small cell lung cancer and rendering the patient inoperable