Association of obesity with rapid virological response in patients with chronic hepatitis C

Objective: To determine the association of obesity with rapid virological response in patients with chronic hepatitis C on antiviral therapy

Methodology: In this prospective cohort study patients suffering from chronic hepatitis C who required treatment were included after getting ethical approval and informed consent. Patient's weight and height was measured and body mass index [BMI] was calculated. Patients were divided into 2 groups; group 1 having BMI <30 and group 2 having BMI >30 in equal numbers. All the patients were put on weekly pegylated interferon plus ribavirin in fixed divided doses. PCR was done at the completion of 4 week to check for rapid virological response [RVR]. After completion of study these 2 groups were compared to see whether any significant association exists between BMI and RVR. RVR was also stratified among age, viral load and gender to see their effect as these are potential effect modifiers

Results: There were 140 [56.3 %] male and 110 [43.7%] female patients with male to female ratio of 1.2:1. Mean age of the patients was 39.78 +/-9.85, while mean BMI was 27.40 +/-5.86. Overall the RVR was achieved in 53.2% of the patients. Frequency of RVR was 77[61.6 %] in non-obese patients as compared to 56[44.8%] in obese patients with a p value of 0.008

Conclusion: Obesity is significantly associated with poor RVR in patients with chronic hepatitis C

Prevalence of amoebiasis in a model research community and its confirmation using stool antigen elisa for Entamoeba histolytica

Entamoeba histolytica [E. histolytica] produces an invasive disease called amoebiasis, which commonly produces diarrhea with or without blood in both children and adults, leading to high morbidity and mortality. Entamoeba dispar [E. Dispar] is a noninvasive, nonpathogenic organism. Both Entamoeba histolytica and Entamoeba Dispar look alike on microscopy and therefore cannot be differentiated unless checked on ELISA, PCR or other specific method. To calculate the actual prevalence of pathogenic amoebiasis in children by comparing the stool microscopy with ELISA stool antigen i.e. gold standard. Across sectional, comparative study. Children under five years in a community village Budhni, District Peshawar. A sample of 288 children aged <5 years were randomly selected. Information's were collected on the age and gender of the children. Fresh stool specimens were examined microscopically and with stool antigen kit of ELISA for detection of Entamoeba histolytica. The specificity and sensitivity of microscopic method was calculated against ELISA. Data was analyzed using statistical computer software package SPSS version 10.0. A total of 288 stool specimens were collected and examined for Entamoeba histolytica. Out of these 36[12.5%] stools were positive for E. histolyticaon microscopy while 14[4.9%] were positive on ELISA. Out of 14 ELISA positive samples, 10 samples were also positive on microscopy while 4 were ELISA positive but microscopy negative. About 22 samples, which were positive on microscopy were negative on ELISA indicating that these samples might have been of E. Dispar which is nonpathogenic protozoa. The sensitivity and specificity of microscopic method was 71.4% and 90.5% respectively, as against stool antigen test. Actual prevalence of Entamoeba histolytica is low in the area. Stool ELISA was able to differentiate between pathogenic Entamoeba histolytica and the non-pathogenic Entamoeba dispar and thus can minimize unnecessary antiamoebic treatment in these children

Response rate of standard interferon therapy in chronic hepatitis C

Interferon combination therapy is used to eradicate the Hepatitis C Virus from infected individuals. HCV [hepatitis C virus] infections respond to standard conventional interferon [INF] therapy along with ribavirin [RBA].The aim of study was to look for response of chronic HCV infections to standard conventional combination interferon therapy and ribavirin. Interventional non randomized trial. This study was carried out at Azad Kashmir Combined Military Hospital [AK CMH]/Sheik Khalifa Bin Zyad [SKBZ] Muzaffarabad [MZD] from June 2009 to July 2012. A total of 210 patients were selected for interferon combination therapy. After confirmation of active HCV infection by PCR-RNA, conventional interferon alpha 2a with ribavirin [RBA] was given to patients for 6 months. After end of treatment [ETR], the efficacy was defined as sustained virological response [SVR] if HCV-RNA remained undetected 6 months after stoppage of combination interferon therapy. Out of total 210 patients, 144 [68.6%] showed SVR and 66 [31.4%] did not show SVR. Hence out of 68.6% were negative and 31.4% were positive for HCV RNA after 6 months of therapy. The non parametric chi squared showed age [p=<0.001], [age category p=<0.001], gender [p=<0.006], and HCV PCR response [p=<0.001] had statistical significant association. Conventional Interferon and ribavirin combination therapy [INF-RBA] remains effective in chronic hepatitis naïve patients. HCV-RNA qualitative PCR test at 6 month of ETR is important predictor of SVR. The response of antiviral therapy against HCV infection in chronic HCV patients is 68.6%. The high response rate may be due to the prevalence of IFN-responsive HCV genotypes type 3 in our country

Klippel-trenaunay syndrome: a rare cause of intermittent lower gastrointestinal bleeding

Klippel-Trenaunay syndrome is a rare non-hereditary congenital abnormality characterized by a clinical triad of soft tissue hypertrophy of extremity, varicosities and cutaneous hemangiomas or lymphongioma. Bleeding per rectum is an uncommon but potentially serious complication. We herein report a case admitted to the gastroenterology ward Postgraduate Medical Institute, Lady Reading Hospital Peshawar, with intermittent haematocezia and symptomatic iron deficiency anemia. The patient did not seek any help for gastrointestinal bleeding until his admission to our unit. He was also having gigantism of his right leg and port wine angiomatous spots on his buttocks and leg. The literature on the evaluation and management on this case is reviewed

Injection sclerotherapy of bleeding gastric varices using absolute alcohol

To evaluate the effectiveness of absolute alcohol injection in the management of bleeding gastric varices. This descriptive study was conducted in the department of Gastroenterology, Hayatabad Medical Complex Peshawar from September 2006 to September 2009. Twenty Seven patients with portal hypertension fulfilling the inclusion criteria and consenting were included in the study. Endoscopy was arranged within 12 hours of admission to the hospital. The gastric varices were injected with 5-10 ml of absolute alcohol depending upon the size of the varices. Both intravariceal and paravariceal techniques were used. Subsequent endoscopy sessions were arranged at 2 weeks intervals. The outcomes assessed were variceal eradication, rebleed and death. Findings were noted and entered into a structured proforma. Data was analyzed using SPSSv.10. Fifteen [55.56%] patients were male and 12 [44.44%] were female with a mean age of 47.52 +/- 15.09 years. Twenty one [77.78%] patients had cirrhosis due to chronic hepatitis C, 4 [14.81%] were HBV related while 2 [7.40%] had alcoholic liver disease. Majority [70.73%] had child's class C followed by B and A [18.51% and 11.11% respectively]. Variceal eradication was achieved in 19[70.37%] patients. Three were lost to follow up while 5 died due to uncontrolled bleeding. Post sclerotheraphy ulceration was the most common complication [64%] followed by pyrexia [28%], Retrosternal/epigastric pain [16%] and dysphagia [8%]. Sclerotherapy with absolute alcohol may be effective in achieving hemostasis in bleeding gastric varices but with exceptionally high rate of complications

Frequency of organic pathologies in patients with irritable bowel syndrome

To evaluate Irritable bowel syndrome [IBS] labeled patients, meeting symptom based criteria of IBS, for organic pathologies. This descriptive study was carried out in Gastroenterology Department, Hayat Abad Medial Complex, Peshawar, during the period from March 2003 to March 2005. A total of 85 consecutive patients were included in the study, who were labeled as IBS by the General Practioners. All of them were meeting symptom based criteria [ROME II] for IBS. Informed consent was taken. Patients with alarm signs including dysphagia, rectal bleeding, anemia, weight loss, family history of colon cancer, were excluded from the study. Detailed history and physical examination was done. Laboratory evaluation, which included complete blood count, erythrocyte sedimentation rate[ESR], blood urea, serum creatinine, serum electrolytes, liver function tests, thyroid function tests, and stool examination for ova, parasites and culture when indicated, was done. Patients underwent Upper G I Endoscopy, Ultrasound of the abdomen, Flexible sigmoidosopy and/or Full length colonoscopy as indicated. Other investigations like small gut biopsy, celiac serology and biopsy from the large gut were done as needed. Out of the 85 patients, 68 [80%] were males and 17 [20%] were females. Abdominal pain was the most common, present in 65 [76%] patients out of 85 patients. All these patients had mixed type of IBS symptoms, having both diarrhea and Constipation. Laboratory investigations were normal in almost all patients except in 5 [5.8%] patients, who were having evidence of hypochromic microcytic anemia. All these five patients were having mixed pattern IBS. Three [3.5%] were males and their celiac serology and small gut biopsy showed evidence of celiac sprue. Ten [12%] of patients were having cysts of Amoeba in their stools routine examination but there were no trophozytes found. Another 15 [17%] patients were having non significant hemorrhoids on lower GI endoscopy. 17 [20%] of patients were having antral gastritis on EGD, but the biopsy showed non specific gastritis. Irritable bowel syndrome can be diagnosed clinically, using ROME II criteria and a few inexpensive and non invasive tests. In patients with IBS-D and IBS-M routine serological screening for celiac sprue may be a cost effective strategy

Causes of severe upper gastrointestinal bleeding on the basis of endoscopic findings

To describe the common causes of severe upper gastrointestinal [GI] bleeding in a tertiary care teaching hospital. This study was carried out in Gastroenterology Department Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar from 1st September 2003 to 31st July 2005. Study was conducted on all patients who presented with severe upper GI bleeding. The patients were first stabilized hemodynamically and were kept empty stomach for at least 6-12 hours before procedure. Upper GI endoscopy was performed and the endoscopic findings were recorded. Out of 350 patients included in the study, 200 [57%] were males and 150 [43%] were females. The age ranged from 14 years to 75 years. Variceal bleed was the most common cause in 45.7% [n=160] cases followed by peptic ulcer in 31.4% [n=110] cases. Gastroesophageal reflex disease was noted in 10% [n=35], carcinoma of the stomach in 5.7% [n=20] of the cases and Mallory-Weiss tears in 4% [n=14] cases. Out of 160 patients with varices, 62.5% [n=100] were having esophageal varices. Out of 110 peptic ulcer cases, 63.6% [n=70] were having duodenal ulcer and 26.4% [n=29] were having NSAID induced peptic erosions. Variceal bleeding secondary to portal hypertension and peptic ulcer diseases are the most common causes of upper G I bleeding in our setup