ABSTRACT
Hepatobiliary fascioliasis is one of the rare but important parasitic infection in endemic areas such as Pakistan. Clinical manifestations overlap with common clinical conditions such as hepatitis and biliary stones causing common bile duct obstruction. Fascioliasis is a zoonotic infection caused by a leaf-shaped organism known as Fasciola Hepatica. Humans are accidentally infected by consuming contaminated water or food, especially undercooked cattle and sheep liver or raw green vegetables. We report three cases with similar clinical manifestations presenting in two different cities in Pakistan. After detailed clinical evaluation and laboratory investigations, the diagnosis was established by abdominal ultrasound and diagnostic and therapeutic cholangiography. Patients were followed till complete resolution of their symptoms and normalisation of liver function tests.
Subject(s)
Fasciola hepatica , Fascioliasis , Humans , Fascioliasis/diagnosis , Fascioliasis/drug therapy , Fascioliasis/parasitology , PakistanSubject(s)
Bile Duct Neoplasms , Cholestasis , Bile Duct Neoplasms/complications , Cholestasis/etiology , Cholestasis/surgery , Humans , StentsABSTRACT
Background and study aims Adenoma detection rate (ADR) is validated for measuring quality of colonoscopy, however there is lack of colorectal cancer (CRC) screening program in South Asia. The purpose of this study is to analyze and review the polyp detection rate (PDR) and ADR and provide insight into the factors that influence them in Pakistan. Patients and methods This retrospective, cross-sectional study was performed at the Aga Khan University Hospital, Karachi, Pakistan, on patients ≥â18 years, who underwent colonoscopy between January 1, 2017 and June 30, 2018. Results Of 1985 patients, 59â% were male and 41â% female, with mean age of 47.8â±â16.2 years. The most common indication for colonoscopy was bleeding-per-rectum (28.0â%) and overall PDR and ADR were 17.9â% and 9.9â%, respectively. There was no significant difference between genders for either PDR ( P â=â0.378) or ADR ( P â=â0.574). Significantly higher PDR and ADR were found for patientsâ≥â50 years ( P â<â0.001), as well as for suboptimal bowel preparation [PDR (25.7â%; P â=â0.007) and ADR (18.6â%; P â=â0.014)]. Interestingly, endoscopists withâ<â500 colonoscopy-procedural-experience reported a higher PDR (21.6â%; P â=â0.020) and ADR (14.4â%; Pâ=â0.049), corresponding to a significantly higher PDR (20.6â%; P â=â0.005) and ADR (11.7â%; P â=â0.02) for endoscopists in practice forâ≤â10 years. Conclusions We have noticed low PDR and ADR, which require further investigation and research. In addition, we believe there should be a different baseline ADR and PDR as a quality indicator for colonoscopy in our region, where no internationally recommended colonoscopic screening programs have been implemented.
ABSTRACT
Sinus histiocytosis with massive lymphadenopathy also known as Rosai-Dorfman disease is a rare benign disease that typically manifests as lymphadenopathy with or without systemic manifestations whose etiology remains poorly understood. Most common clinical presentation is painless bilateral cervical lymphadenopathy. However, it also can present in various extranodal sites and can easily be missed because of its rarity if not considered in the differential diagnosis. It commonly occurs in children and young adults with a slightly male predominance. Clinically patients may be mistaken for lymphoma and other infectious disorders like tuberculosis especially in developing countries like in Pakistan where tuberculosis is more prevalent. Here we report a case of a 38-years-old gentleman with bilateral cervical lymphadenopathy and worsening ascites. His symptoms initially mimicking tuberculosis and lymphoma, was finally diagnosed as having Rosai-Dorfman's Disease on intra abdominal lymph node biopsy.