Intestinal spirocheteosis in a patient with celiac disease

A young girl presented to us with recurrent diarrhea along with a history of 5 kg weight loss in one year. On examination, she appeared pale, while her laboratory reports showed a low hemoglobin, mean corpuscular volume [MCV] and serum albumin. Her erythrocyte sedimentation rate [ESR] was slightly raised with her iron profile suggestive of iron deficiency anemia. Viral markers, human immunodeficiency virus [HIV] serology along with thyroid profile were all unremarkable. There was no history of tuberculosis, and purified protein derivative [PPD] skin test was also negative. Computed tomography [CT] abdomen showed thickening of the terminal ileum with multiple enlarged lymph nodes. An esophagogastroduodenoscopy [EGD] along with colonoscopy was done. Multiple biopsies were taken, which were suggestive of sprue along with intestinal spirochetosis. Her tissue transglutaminase [TTG] was negative while deamidated gliadin peptide [DGP] was positive. She was kept on gluten-free diet and started on tablet metronidazole. This case shows that intestinal spirochetosis should be kept in mind in patients belonging to lower socio-economic status, who present with chronic diarrhea symptoms

Hepatic Sarcodosis presenting as portal hypertension in a young boy

A 13-year-old boy, known case renal stone disease came with the complaints of abdominal pain along with low grade fever. On examination, hepatosplenomegaly was noted while his lab reports showed a low hemoglobulin with a raised ESR. His blood and urine cultures showed no growth. Viral markers, autoimmune profile, C and p ANCA were all negative apart from a raised serum IgG level. Ultrasound abdomen showed a hyperechoic liver with an enlarged spleen along with splenic varices and minimum ascites. Ultrasound hepatic doppler was normal. Serum AFP levels were normal while workup for Wilson's disease was negative. Fibroscan showed F4 fibosis. CT scan abdomen showed an enlarged left lobe of the liver along with an enlarged spleen. His EGD revealed varices. So liver biopsy was done that was suggestive of chronic granulomatous disease with ZN stain testing negative for TB.PPD, urine for AFB were both negative. Serum ACE levels were raised. He started ATT therapy but his condition did not improve. So, on the suspicion of hepatic sarcoidosis, he started on steroids and had a drastic improvement in his condition

use of Karnofsky Performance Status [KPS] as a predictor of 3 month post discharge mortality in cirrhotic patients

Aim: Is Karnofsky Performance Status [KPS] a predictor of 3 month post discharge mortality in cirrhotic patients?

Background: Cirrhotic patients often experience an abrupt decline in their health, which often leads to frequent hospitalization and can cause morbidity and mortality. Various models are currently used to predict mortality in cirrhotics however these have their limitations. The Karnofsky Performance Status [KPS] being one of the oldest performance status scales, is a health care provider - administered assessment that has been validated to predict mortality across the elderly and in the chronic disease populations

Methods: We used the KPS performance status scale to envisage short-term mortality in cirrhotic and HCC patients who survive to be discharged from hospital

Results: Our study showed that KPS one week post-discharge, child pugh score, hospital stay, international normalized ratio, serum albumin, total bilirubin and serum creatinine showed statistical significance on univariate analysis. On multivariate analysis, KPS was found to be statistical significant predictor of 3-month mortality

Conclusion: Hence KPS can be utilized to identify cirrhotic patients at risk of 3-month post discharge mortality

Genotype distribution of hepatitis C Virus in district Jacobabad, Sind, Pakistan and the risk factors associated with it

Objectives: Our study focused on HCV's genotype distribution in district Jacobabad and its associated risk factors

Study Design: Cross sectional study

Place and Duration of Study: This study was carried out at a Private Clinic in Jacobabad, Sind, Pakistan from January 2013 to July 2013

Materials and Methods: 153 samples were collected and their HCV status was confirmed by PCR

Results: Out of 153 people, 100 were male and 53 females .Majority of the people were natives of Jacobabad city [90%].Genotype 3 was the most prevalent form [80%] with 3a being the most prevalent subtype.65% had a history of using unsterilized needle of which 3a had the highest association [87.4%].5.5% of the subjects had received transfusions during their lifetime, with type 1 and 4 genotype having a 50% history of it.69% had no history of sharing needles. 12.2% had a history of surgical intervention

Surgery had a 100% associated with genotype 1. 2.5% had received dental treatments in the past, most evident with types 3 [65%].61.4% had visited their barber recently .6.3% people had ever received a tattoo, while majority of the people [92.8%] had no history of drug addiction

Reports of accidental pricks, sexual contacts or transmissions during delivery were negligible

History of tattooing, accidental pricks and transmission via sexual contact were mostly seen with type 3.No apparent cause of HCV was seen in 15%

Conclusion: Unsterilized needles and visits to the barbers for shaving are a major risk factor for Hepatitis C in this region of Pakistan. This could be attributed to the lack of knowledge about these dangerous practices

Clinician's views on reporting by the radiology department of a tertiary care hospital in Karachi

There are no standard radiological reporting formats therefore reporting varies from person to person. Clinicians are the users of these reports and their satisfaction on reporting can improve the credibility of the radiology department. To obtain clinician's views and assess their satisfaction regarding the current reporting service by the radiology department and to determine ways of improving it. This was a cross sectional study consisting of two main sections. The first section dealt with the existing reporting style while, the second was about the clinician's preferences on the format of reporting. It was a questionnaire based study where senior physicians representing all departments utilizing the services of the radiology department who consented to participate in the study were included. The results were described as frequencies while, percentages and significance was tested using chi square test. Clinicians were unsatisfied with the detail, timeliness and print quality of the reports. However, clarity and correctness were rated high. Computed Tomography scan was the most satisfactory service offered by the radiology department. Substandard film quality was the most common reason given for requesting a repeat investigation. Clinicians supported the idea that radiologists should give recommendations not only for further radiological investigations but also for non-radiological investigation and further referrals. Most clinicians were unaware of normal size of common body organs. There is a need to enhance communication between the clinician and the radiologist to ensure high quality reporting standards