Seroprevalence of Hepatitis-E Virus-Immunoglobulin G and its association with Chronic Liver Disease.

Background & Objective: Viral hepatitis is a major public health concern in low-middle income countries. Hepatitis-E infection (HEV) is found globally but most prevalent in low-income countries especially those with poor sanitation systems, access to clean drinking water and health services. Superinfection with HEV in patients with chronic liver disease (CLD) can cause severe hepatic decompensation leading to increased morbidity and mortality. To determine the frequency of seroprevalence of Hepatitis-E virus Immunoglobulin g (IgG) and its association with chronic liver disease. Methods: A cross-sectional study was conducted in Asian Institute of Medical Sciences, Hyderabad, Pakistan from January till May 2022. A total of 196 patients of aged ≥ 18 years, presenting in gastroenterology clinics were included in the study after informed consent. Result: Among 196 patients, one third of patient were male (73.5%). Out of which 162 (82.7%) had liver disease and 34 (17.3%) were without liver disease. The median age of patient was 45 (33-51) years. The overall seroprevalence of HEV IgG among study population was 69.4%. HEV IgG was present in 114 and 22 in CLD and non CLD patients respectively. Multivariable regression shows no association between seroprevalence of HEV in CLD and non-CLD patient (AOR 1.02, 95% CI 0.45-2.313). Conclusion: Our study showed high frequency of HEV seropositivity. No difference was observed in HEV seropositivity among CLD and non-CLD patients.

Comparison of viral hepatitis-associated hepatocellular carcinoma due to HBV and HCV - cohort from liver clinics in Pakistan.

BACKGROUND: Hepatocellular carcinoma (HCC) is the first cause of death in cirrhotic patients, mostly due to viral hepatitis with HCV or HBV infection. This study was performed to estimate the true prevalence of viral hepatitis-related HCC and the demographic and clinical-pathological associations with the two virus types. MATERIALS AND METHODS: This cross sectional observational study enrolled clinical data base of 188 HCC patients and variables included from baseline were age, sex, area of residence, clinical-pathological features such as underlying co-morbidity, presence or absence of liver cirrhosis, macrovascular involvement, tumor extension and metastasis, liver lobes involved, serum alpha-fetoprotein level, and hepatitis serologies. RESULTS: Overall prevalence of HCV- and HBV-related HCC was 66.0% and 34.0%, respectively. Patients with HCV were more likely to develop HCC at advanced age (52.4±11.9 vs. 40.7±12.09 years), with highly raised serum AFP levels (≥400ng/ml) 78.2% (HBV 67.1%), large tumor size (HCV-66% >5 cm, HBV-59.3%), and presence of portal vein thrombosis (8.06%, HBV 1.56%). A binominal multivariate analysis showed that HCV-HCC group were more likely to be cirrhotic (OR=0.245, 95%CI: 0.117, 0.516) and had more than two times higher rate of solitary macrovascular involvement (OR=2.533, 95%CI: 1.162, 5.521) as compared with HBV associated HCC. CONCLUSIONS: Statistically significant variations were observed from baseline to clinical-pathological characteristics in HCV vs HBV associated HCC. Our study suggests prompt and early screening for high risk patients so that the rate of progression of these chronic viral diseases to cirrhosis and cancer can be decreased.

Morbidity and Mortality of Malaria during Monsoon Flood of 2011: South East Asia Experience.

BACKGROUND: Malaria is the second most frequent clinically suspected disease entity after acute respiratory tract infection in developing countries. Active malarial transmission occurs throughout the year, while aggressive out bursts of disease are seen mainly during and after the 'monsoon' season. This study aimed to determine the morbidity and mortality associated with malaria during flood at Isra University Hospital, Hyderabad. METHODS: This prospective observational study was done at Isra University Hospital Hyderabad during monsoon flooding from July 2011 to October 2011. All 883 patients presented with symptoms of malaria (fever, headache, and vomiting) were evaluated and diagnostic tool ICT-MP was used for the detection of malaria parasite among them. RESULTS: Seventy four (8.38%) patients diagnosed for malaria. The mean age and SD was 30.11 ± 1.67 years. Overall mortality due to malaria observed (18.9%). Mortality rate significantly observed high in pregnant women (0.005) and in those patients who developed complications such as, pneumonia (P = 0.04), renal failure (P = 0.04), Unconsciousness (P = 0.001), and Septicemia (P = 0.001). CONCLUSION: A Significant increase in the morbidity and mortality in patients with malaria after flood noticed. The probability of getting poor outcome is also associated when patient develop complications.

Prevalence of type 2 diabetes mellitus in hepatitis C virus infected population: a Southeast Asian study.

PURPOSE: The study was aimed to investigate the frequency of diabetes mellitus type 2 in patients infected with chronic hepatitis C virus and its association with cirrhosis. PATIENTS AND METHODS: This prospective case series was conducted at Section of Gastroenterology and Hepatology, Isra University Hospital, Hyderabad, over a period of 4 months from June 2009 to October 2009. Hepatitis C virus seropositive patients who were older than 18 years, diabetic or nondiabetic, were included. Basic demographic data collected by questionnaire and laboratory investigations including fasting blood glucose levels, serum cholesterol, and liver function tests were done. A logistic regression model was used to explore the association between diabetic and nondiabetic HCV seropositives and type 2 diabetes mellitus with cirrhosis. RESULTS: A total of 361 patients with hepatitis C were analyzed; the prevalence of type 2 diabetes mellitus in HCV patients was 31.5%. Out of the total number of the participants, 58.4% (n = 211) were cirrhotics, while 41.6% (n = 150) were noncirrhotic HCV seropositives. In multivariate analysis, cirrhotic patients appeared significantly more likely (P = 0.01) to be diabetic as compared with noncirrhotic patients (OR = 2.005, 95% CI: 1.15, 3.43). CONCLUSION: Advancing age, increased weight, and HCV genotype 3 are independent predictors of type 2 diabetes in HCV seropositive patients, and there is a statistically significant association of cirrhosis observed with type 2 diabetes mellitus.

Secondary gastric varices in hepatic cirrhosis.

OBJECTIVE: To determine the frequency of secondary gastric varices after esophageal variceal eradication in patients with cirrhosis of liver and factors associated with their development. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Department of Gastroenterology, Liaquat University Hospital, Jamshoro and Isra University Hospital Hyderabad, from September 2007 to July 2009. METHODOLOGY: 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. RESULTS: 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). CONCLUSION: 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.

OBJECTIVE: To determine the safety of self expandable metallic stent (SEMS) placement under endoscopic guidance without fluoroscopy. STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF 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. METHODOLOGY: 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. RESULTS: 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. CONCLUSION: 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.

OBJECTIVE: 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. PLACE AND DURATION OF STUDY: Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2005 to March 2007. METHODOLOGY: 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. RESULTS: 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. CONCLUSION: 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.

OBJECTIVE: 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. STUDY DESIGN: Non-interventional case control study. PLACE AND DURATION OF STUDY: Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, from October 2007 to March 2008. METHODOLOGY: 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. RESULTS: 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). CONCLUSION: 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.