ABSTRACT
Objective: Zinc is a vital trace element and its deficiency in cirrhosis might potentiate the development of hepatic encephalopathy. The objective of this study was to assess the zinc levels in serum of patients having viral cirrhosis and compare it with normal healthy controls
Methods: This study was conducted in Department of Gastroenterology, Liaquat National hospital and medical college, Karachi, Pakistan; from January 2014 to December 2014. Total of 45 patients with the mean age of 52.44+/-8.7 years were included. The three groups of patients were made including Child Pugh Class Score B [Group-1], Child Pugh Class C [Group-2] and healthy controls [Group-3] having 15 patients in each group. Zinc levels in serum were evaluated by the help of atomic absorption spectrometry [Normal range50-150 micro g/dl]
Results: Total of 45 subjects was enrolled in this study. Overall prevalence of zinc deficiency was noted in 13[28.9%] patients. Mean value of zinc levels in group 1, 2 and 3 were 68.09+/-20.85, 50.69+/-15.86 and 92.91+/-17.18 micro g/dL respectively. Highly statistical difference was observed in the mean zinc level between three groups p=0.0001. An inverse correlation was observed between Child Pugh Score and the zinc level in serum r=-0.498
Conclusion: Patients suffering from advanced cirrhosis appeared to have lower serum zinc levels.In patients suffering from viral cirrhosis having hepatic encephalopathy, zinc supplementation might improve clinical outcome
ABSTRACT
Objective: The uridine nucleotide analogue sofosbuvir is a selective inhibitor of hepatitis C virus [HCV] NS5B polymerase approved for the treatment of chronic HCV infection with genotypes 1 - 4. The objective of the study was to evaluate the interim results of efficacy and safety of regimens containing Sofosbuvir [Zoval] among Pakistani population with the rapid virologic response [RVR2/4 weeks] with HCV infections
Methods: This is a multicenter open label prospective observational study. Patients suffering from chronic Hepatitis C infection received Sofosbuvir [Zoval] 400 mg plus ribavirin [with or without peg interferon] for 12/24 weeks. The interim results of this study were rapid virological response on week 4. Data was analyzed using SPSS version 21 for descriptive statistics
Results: A total of 573 patients with HCV infection were included in the study. The mean age of patients was 46.07 +/- 11.41 years. Out of 573 patients 535 [93.3%] were treatment naive, 26 [4.5%] were relapser, 7 [1.2%] were non-responders and 5 [1.0%] were partial responders. A rapid virologic response was reported in 563[98.2%] of patients with HCV infection after four weeks of treatment. The treatment was generally well tolerated
Conclusion: Sofosbuvir [Zoval] is effective and well tolerated in combination with ribavirin in HCV infected patients
ABSTRACT
Objective: The objective of the study is to find out, the levels of thyroid hormones in serum of the patients having decompensate cirrhosis and to determine the frequency of signs and symptoms of thyroid dysfunctions in such patients. Study design: Prospective descriptive study. Setting: All medical wards of Civil Hospital and Ojha campus, Dow University of Health Sciences, Karachi, Pakistan. Period: May 2013 to January 2015
Methodology: 76 patients having decompensated liver cirrhosis with various presentations, which were fulfilling the inclusion and exclusion criteria and were admitted in medical wards during the study period, were included in this study. Detailed history and examination of each case was performed. Thyroid hormone levels were performed along with other relative laboratory investigations and the results were obtained
Results: Out of 76 patients 58 patients had low serum T3 levels, whereas 18 had normal T3 levels. 65 patients had normal T4 levels and 11 had low serum T4 levels. The TSH levels were found normal in 74 patients and two patients had raised TSH levels
Conclusion: It is concluded that T3 levels is low in cirrhotic patients but at the same time T4 and TSH levels remains normal in majority of cases and the patients remain euthyroid. As far as the clinical scenario is concern, no significance was found in the frequency of sign and symptoms of thyroid dysfunction. Most of the patients did not show signs and symptoms of hyper and hypothyroids
Subject(s)
Humans , Male , Middle Aged , Female , Adult , Aged , Thyroid Hormones/blood , Prospective StudiesABSTRACT
Colonoscopy is one of the most important modalities to investigate complaints related to lower gastrointestinal tract. Terminal ileum is an essential part of the complete colonoscopic examination. Objectives: To observe the diagnostic yield of ileoscopy in patients undergoing colonoscopy. Design: Retrospective and observational study. Period: January 2010 to May 2014. Setting: Liaquat National Hospital and Medical College. Patients and methods: Patients undergoing colonoscopy fulfilling inclusion and exclusion criteria were enrolled. Terminal ileum was examined and biopsies taken if abnormality present. Statistical analysis was done by SPSS- 18. Result: A total of 1296 patients were included, 884 [68.2%] were male and 412 [31.8%] were female. Age ranged from 15-90 years. The commonest indication was bleeding per rectum [35.6%].1133[87.4%] patients had normal mucosaand163 [12.6%] had abnormal mucosa on ileoscopy. Of these 163 patients, 68 had ulcers, 56 had inflammation, 29 had nodular mucosaand10 had polyp. Histopathological examination showed non-specific inflammation in 139 patients; granulomatous inflammation in 7; reactive lymphoid hyperplasia in 8; 3 had normal result; biopsies were not taken in remaining 6 patients. By using chi-square test we found a significant statistical relationship between macroscopic abnormality of terminal ileum mucosaandage of patients, weight loss, chronic diarrhoea, and abdominal pain. On logistic regression, age group, chronic diarrhoeaandweight loss retained strong relationship with macroscopic abnormality of terminal ileum mucosa. Conclusions: Though a large number of patients [12.6%] had abnormal terminal ileum mucosa, histopathological analysis did notshow any significant yield of ileoscopy. Terminal ileal abnormality was more common in young and middle aged patients and in patients presenting primarily with chronic diarrhoeaandweight loss.
ABSTRACT
Objectives: To observe the frequency of QTc [corrected QT] interval prolongation in patients with chronic liver disease in our population
Study design: A cross-sectional analytical study
Place and duration: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi from May 2009 to October 2009
Methodology: A non- probability, purposive sampling is used in already diagnosed cirrhotic patients. Patients between 25-70 years were included. These patients were divided into three groups according to their Child-Pugh [C.P.] classification [class A, class B and class C]. An electrocardiogram [ECG] of all patients was obtained and QT intervals corrected for heart rate [QTc] were calculated. Analysis of data was done by SPSS 17
Results: 121 cirrhotic patients were inducted in this study. 10 patients belonged to C.P. class A, 49 to C.P. class B, and 62 to C.P. class C. Prolonged QTc interval was observed in 48 [39.7%] patients while in 73 [60.3%] patients QTc interval was normal. Occurrence of prolonged QTc interval was greater in C.P. class-C [50%] followed by C.P. class-B [30.6%], p value 0.045 and 0.016 respectively
Conclusion: Significant number of cirrhotic patients had prolonged QTc interval and this prolongation of QTc interval was directly associated with more advanced liver disease
ABSTRACT
To determine the frequency of H. pylori infection in dyspeptic patients undergoing endoscopy at a tertiary care center in Karachi. Patients undergoing endoscopy at Liaquat National Hospital, Karachi. Cross sectional descriptive study. Department of Gastroenterology, Liaquat National Hospital, Karachi. May 2008-October 2008. All adult patients with symptoms of dyspepsia for more than 1 month duration were included. Patients with upper gastrointestinal bleed, anemia or weight loss were excluded. Upper gastrointestinal endoscopy was performed in all patients and biopsy specimens two each from antrum and body and one from fundus were taken for histology. A total of 123 dyspeptic patients were included in the study. 76 [61.8%] patients were males and 47 [38.2%] were females. H pylori was detected in mucosa of 49 [39.8%] patients. The mean age of the patients was 41.41 +/- 13.15 Years [95%CI; 39.06 to 43.75]. Rate of H.pylori infection was not found statistical significant with age, gender, duration of symptoms and BMI. The prevalence of H pylori infection in dyspeptic patients was lower than reported in previous studies from other centers in Pakistan. Other environmental factors should be evaluated in every patient especially who is negative for H. pylori in our setup
ABSTRACT
Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. This is a report of a 62 years old female who presented with complaint of persistent vomiting and upper abdominal pain for the last 5 days. Ultrasound abdomen was suggestive of pneumobilia. CT scan of upper abdomen showed cholecystoduodenal fistula and complete obstruction of third part of duodenum by a large stone, which was reported as Bouveret's syndrome. She underwent emergency gastroscopy. The stone was retrieved by Dormia basket, crushed with lithotripter and extracted endoscopically. Complete intestinal obstruction was relieved endoscopically
ABSTRACT
N-butyl-2-cyanoacrylate is widely used to sclerose bleeding gastric varices. We report the case of a 65-year-old lady, known case of cirrhosis secondary to hepatitis C infection, who presented to the emergency department with coffee ground vomiting and melena for four days. Gastroscopy showed non-bleeding small esophageal varices, mild portal hypertensive gastropathy and a large gastric fundal varix. Injection sclerotherapy was completed successfully and haemostasis was secured. During the procedure, she was hemodynamically stable with an oxygen saturation of 98%. Immediately after the procedure, she went into cardiopulmonary arrest; cardiopulmonary resuscitation [CPR] was started, but she could not be revived. A provisional diagnosis of pulmonary embolism was made. X-ray chest showed linear hyperdense shadows in both pulmonary arteries and in some of their branches, which were not seen on pre-procedural chest X-ray. The patient died of massive pulmonary embolism as confirmed on X-ray chest
ABSTRACT
To determine the frequency of factors leading to post endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis. Case series. Department of Gastroenterology, Liaquat National Hospital, Karachi, from November 2007 to October 2008. Fifty [50] patients of diagnosed cases of post-ERCP pancreatitis were included in this study. The collected data included age, gender, previous post-ERCP pancreatitis, recurrent pancreatitis, recurrent abdominal pain, number of attempts of common bile duct [CBD] cannulation, difficult CBD cannulation, precut sphincterotomy, biliary sphincterotomy, pancreatic duct contrast injections, primary diagnosis, device used, therapeutic procedure undertaken and the pancreatic enzymes level. Results were described as frequency percentages. Out of 50 patients, 32 [64%] were females. The average age of the patients was 52.23 +/- 13.4 years. Frequency of common factors regarding post-ERCP pancreatitis were age 2 60, [n = 38, 76%] patients, female gender [n = 32, 64%], precut sphincterotomy [n = 34, 68%], pancreatic duct contrast injections [n = 27, 54%], biliary sphincterotomy [n = 25, 50%]. Higher number of attempts of CBD cannulation and difficult CBD cannulation were recognized as factors for post ERCP pancreatitis. Other factors like previous history, post-ERCP pancreatitis, recurrent pancreatitis, and recurrent abdominal pain were not found in this study. Age, female gender, precut papillotomy, pancreatic duct contrast injections and biliary sphincterotomy were common factors for post-ERCP pancreatitis. Risk stratification will allow endoscopists to better identify patients who are at risk and permit detailed informed consent in high-risk groups or to adapt the measures to prevent the complications and reduce the risk related with the procedure
Subject(s)
Humans , Male , Female , PancreatitisABSTRACT
Portal Hypertensive Gastropathy [PHG] is a rare cause of upper gastrointestinal bleeding in patients with Chronic Liver Disease [CLD]. This is the case report of a 46-year-old female known case of Hepatitis C Virus [HCV] CLD, who presented with melena and coffee ground vomitings for 6 months. Esophagogastroduodenoscopy [EGD] showed PHG while an ultrasound revealed chronic liver disease. The patient had a history of repeated blood transfusions over the last 6 months. She was given propanolol but no benefit occurred. She was referred for transjugular intrahepatic portosystemic stenting [TIPSS] to an interventional radiologist, which was followed by a reduction in PHG and the need for transfusion