Diffuse large B-cell lymphoma as an extra-hepatic manifestation of hepatitis C and co-infection of helicobacter pylori: A case report.

Along with infecting hepatocytes, the Hepatitis C virus (HCV) is also a lymphotropic virus. Chronic HCV infection can mutate the Bcl2, a proto-oncogene that inhibits apoptosis. This causes continuous stimulation of B lymphocytes, which results in clonal growth of these immunoglobulin-producing cells. In Western countries, there is a well-documented link between HCV and lymphoproliferative illness. HCV and Non-Hodgkin lymphoma (NHL) have been found to be significantly correlated in Europe, Japan, and the southern United States. There, however, has been no association found in central and northern Europe, the northwestern United States, and some Asian countries. A literature deficit exists in South Asia about the incidence of HCV infection in lymphoma patients. Here, the first documented instance of Diffuse Large B-cell NHL (germinal center type) is reported in a 35-year-old patient. The patient presented to the outpatient department at Ruth KM Pfau, Civil Hospital Karachi, in July of 2022, with the chief complaints of altered bowel habits due to involvement of the anorectal junction and concomitant infection by Helicobacter pylori with a prior history of HCV infection.

Comparison of efficacy of daily and alternate day maintenance treatment of GERD with Vonoprazan 10-mg using Gastroesophageal Reflux Disease Symptom Assessment Scale.

Objectives: To compare efficacy of 10-mg of vonoprazan daily & on alternate days by Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS). Method: This prospective interventional cohort was done at Department of Medicine/Gastroenterology Dow Medical College, Karachi, Pakistan during the period August 2022 & January 2023. Potential participants fulfilling inclusion and exclusion criteria were asked to fill out GSAS questionnaires after their written consent. Patients were allocated in to two groups using random tables. Group-A was given Tab Vonoprazan 10-mg daily for two weeks. Group-B was given Tab Vonoprazan 10-mg on alternate day. GSAS was scored by totaling scores across symptoms and then they are divided by the total number of non-missing symptom scores. Both groups were assessed week-0 & week-2. Results: Only 90 proformas that were completely filled were included, Group-A had 30 males and 15 females while Group-B had 29 males and 16 females. No significant difference in score was found in GSAS score at week-0 except that in item 'gurgling' while at week two there was no significant difference between any of the items. Total GSAS score were significantly lower at Week-2 than at week-0 (p = <.001). Conclusions: Vonoprazan of 10-mg on alternate day is equally effective as 10-mg daily in maintenance of GERD patients at two weeks.

Validation and exploratory factor analysis of Urdu Version of Chronic Liver Disease Questionnaire.

Objective: To present and validate psychometric properties of Urdu version CLDQ, yet another objective was to do exploratory factorial analysis (EFA) of CLDQ Urdu version. Methods: This Cross-sectional Analytical Study was conducted at Dr. Ruth K.M. Pfau Civil Hospital Karachi during the period Nov. 15, 2021 to Jan. 30, 2022. CLDQ Urdu questionnaire was self-administered by the patients. The questionnaire consisted of 29 items and responses were recorded on 7-point Likert type scale. Reliability testing was done by Cronbach's α, test value of >0.7 is taken as reliable. Exploratory factor analysis (EFA) was conducted with principal component analysis with varimax rotation. Adequacies for conduction of EFA depended on Kaiser-Meyer-Olkin (KMO) value of ≥0.5 and Bartlett's Test of Sphericity (BTS) of ≤0.05. Mean CLDQ Urdu scores were also compared with Child Class using ANOVA and post-hoc analysis was done. Results: A total of 320 patients were selected after informed consent. All conditions for adequate EFA were met (Cronbach's α =.949; KMO = .846; BTS ≤.001). Mean CLDQ Urdu score was 156.74 in male and 133.27 in female (p<.001). Child Class-A had best quality of life with score of 186.63 ±6.91 and Child Class-C had the worst with scores of 109.78 ±21.33. EFA resulted in reduction of domains to 4 (Muscular Symptoms, Emotional Symptoms, Abdominal Symptoms & Somnolence) & reduced the number of items from 29 to 11. Conclusion: Urdu CLDQ version is validated in our settings. EFA resulted in reductions in number of domains and items. CLDQ Urdu showed that quality of life decreases significantly with Child Class.

Comparison of Vonoprazan and Amoxicillin Dual Therapy with Standard Triple Therapy with Proton Pump Inhibitor for Helicobacter Pylori eradication: A Randomized Control Trial.

Objectives: To compare the efficacy of Vonoprazan based dual treatment versus PPI based treatment for the eradication of Helicobacter pylori infection. Methods: A randomized controlled trial was conducted in Department of Medicine/Gastroenterology Ruth KM Pfau Civil Hospital, DMC during the period of 22 June to 21 September 2021. Sample size was calculated as 96 in each Group. All patients of age 18-75 years with Helicobacter Pylori Infection were inducted and randomly allocated to two groups. Group-A: were given Capsule Amoxicillin 1 gm; Tablet Clarithromycin 500 mg; Capsule Omeprazole 20 mg all medications were given twice daily for two weeks. Group-B were given Capsule Amoxicillin 1 gm; Tablet Vonoprazan 20 mg (Vonozon©, m/s Getz Pharma, Pakistan) twice daily for two weeks. Confirmation of Hp eradication was done by stool Hp antigen test four weeks after completion of treatment. Nine and four patients were lost to follow-up in Group-A & B respectively. Analysis was conducted on 87 patients in Group-A and 92 patients in Group-B. Results: Out of eighty-seven patients in Group-A and ninety-two patients in Group-B, 73 (83.9%) patients in Group-A and 86 (93.5%) patients in Group-B had negative H pylori result respectively after treatment (p = .042). Significantly higher frequencies of adverse events were observed in Group-A as compared to Group-B in nausea/vomiting (p = .035) and bloating (p = .045). Conclusion: VA-dual provides an acceptable eradication rate with fewer adverse events.