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[en] Objective: To find out and compare the risk factors for hepatitis Band C infections in patients visiting a gastroenterology clinic. Design: A case-control study. Place and Duration of Study: The Liver Stomach Clinic, Karachi, from July 2004 to September 2004. Patients and Methods: Patients of hepatitis Band C visiting the clinic were interviewed and data were noted on a prescribed form. Patients with dyspeptic symptoms who were negative for both hepatitis Band C were taken as controls. Statistical analysis was done using SPSS package. Results: Total numbers of patients interviewed were 148; 63 with hepatitis C, 41 with hepatitis B and 44 in the control group. These patients hailed from various parts of Pakistan with diverse ethnicity. Comparing hepatitis C with the control group, important risk factors identified were lower level of education, the occupational exposure to the blood and syringes, history of blood transfusions, taking therapeutic injections and intravenous drips, and habit of getting shaved by barbers. Patients of hepatitis B were younger as compared to the control group. Their knowledge about spread of infection was poor. These patients had not received hepatitis B vaccine during childhood. Less number of risk factors could be identified in this group, Shaving from the barber's shop was also found to be a risk factor just like in hepatitis C. Conclusion: There is a need to educate general population about the possible risk factors associated with the spread of hepatitis C and B. Proper screening of blood products and universal precautions against the spread of infections are recommended. Treatment by in drips and getting shaved by barbers should be discouraged. Vaccination against hepatitis B is recommended. (author)
[en] Hepatitis is recognized as significant public health problem worldwide. There are one hundred and seventy five million Hepatitis C virus carriers around the world. Global prevalence ranges from 0.1 to 5 % with an average of 3 %. There are very few studies done at national and international levels to find the prevalence of HCV in our population. It is a Picorna virus that may invade the body usually through, intra venous devices and contaminated instruments. It may remain silent for years or cause acute hepatitis to chronic liver disease. Hepatocellular carcinoma is well known complication. Most of the epidemiological studies have so far been carried out on the population with high socio-economic status attending tertiary care hospitals in the cities that have good sterilization techniques. Whereas rural dispensaries are the drainage zones for HCV due to unqualified and untrained technical staff and lack of sterilization procedures. We, therefore, selected some villages (Chirah, Tumair, Thanda pani and Alipur) around Islamabad to assess the prevalence of HCV and tried to compare different epidemiological factors with urban areas in this randomized cross-sectional study conducted from May to August 2009. Two hundred asymptomatic volunteers were randomly selected from patients attending local dispensaries in this study zone. The subjects were given a detailed questionnaire to study and fill accordingly. Details of study were explained to them. Patients included in the study were between 20-50 years of age, having gastrointestinal symptoms. Excluded subjects were pregnant women, patients on ant-viral therapy and known cases of HCV. 5 cc blood samples were taken and transported in ice containers to PINSTECH Complex Hospital laboratory within two hours for chromatographic analysis. We observed that 16.5% of the individuals were infected with HCV. Invasive procedures like D and C by dais and ear piercing were the major transmitting factors in females, whereas I/V devices, dental treatments and barber cutting in males was the dominant risk factors. The use of non disposable glass syringes for injection was also an important mode of transmission. (author)
[en] Aim: To determine the frequency of non-variceal upper gastro-intestinal bleeding (NVUGIB) in patients of liver cirrhosis. Methods: A total number of 136 patients of liver cirrhosis having upper GI bleeding who presented in medical emergency of Nishtar Hospital Multan were included in this cross-sectional analysis. Gastric Endoscopy was done all patients to determine the presence of NVUGIB in all patients. Data regarding patient’s age, Body mass index (BMI), gender and duration of upper GI bleed was also collected. Results: Mean age was 47.23±9.45 years. Mean body mass index (BMI) was 24.94±3.35 kg/m2. Mean duration of upper UGIB was 3.45±3.03 months. There were 94(69.12%) male and 42(30.88%) female patients. NVUGIB was found in 76(55.88%). There was a significant association of age with NVUGIB. In patients of age 20-49 years, NVUGIB was found in 47(62.7%) patients. In having age 49-65 years, NVUGIB was found in 29(47.5%) patients. Conclusion: NVUGIB in patients with liver cirrhosis is very common and it is more common in younger age patients. So diagnostic endoscopy should be done in liver cirrhosis patients presenting with upper GI bleeding in emergency departments. This will aid in proper diagnosis and in deciding the appropriate treatment in these patients. (author)
[en] Seventy patients (17 men and 53 women) were seen with radiation-injured gut between 1958 and 1984. The median age at treatment with radiotherapy was 54 years. External radiotherapy was used in all cases, combined with internal treatment for cervical cancer. Ninety-seven gastrointestinal lesions were produced. There were 63 strictures, 14 fistulas, 12 perforations, and eight bleeds. The period between radiotherapy and clinical manifestation of the lesion was approximately 2 years, being longest for strictures. The majority of the lesions were in the rectosigmoid or mid and distal small bowel. Sixty-one patients required one or more operations, and review of the operative results up to 1977 showed a high incidence of anastomotic leak and death after resection and primary anastomosis. However, we noticed that the ascending, transverse, and descending colon were relatively free of radiation-induced disease. Since then we have used a nonirradiated part of the colon for one end of the anastomosis. Thus terminal ileal resection has been followed by an ileotransverse anastomosis and rectosigmoid resection by mobilization of the splenic flexure to bring it down for anastomosis. With these techniques there has been one leak in 14 anastomoses and none of the 12 patients have died. These results are significantly better (p less than 0.02) than our previous figures when 14 of 27 anastomoses leaked, with 10 deaths. We conclude that use of nonirradiated bowel for at least one end of an anastomosis significantly improves the results of resection of irradiated bowel
[en] We investigated the incidence of gallstone detected by ultrasound in cirrhotic patients, and it was compared with that of the general population. One hundred and seventy seven patients with proven or suspected liver cirrhosis were evaluated sonographic ally to determine the presence of gallstone. We classified 177 cirrhotic patients into A,B, and C by Child classification and investigated the incidence of gallstone for each class. The control group was 363 general population with age distribution and sex-ratio similar to cirrhotic patients.Gallstone was visualized by ultrasound in 32(18.1%) of 177 cirrhotic patients. The incidence of gallstone was 13.1% in Child A, 21.0% in child B, and 20.0% in Child C cirrhotic patients. Overall incidence of gallstone was 3.9% in 363 general population. In summary, the incidence of gallstone was significantly higher in cirrhosis patients than in general population(p<0.01). The patients with moderate and severe cirrhosis showed higher incidence of gallstone than the patients with mild cirrhosis(20.5% vs 13.1%)
[en] To determine the association of gallbladder (GB) abnormalities on ultrasonography (US) of patients with acute hepatitis A with demographic, clinical, and biochemical factors, and with other US findings. This retrospective study was approved by our institutional review board, which waived the requirement for informed consent. We retrospectively evaluated 152 consecutive patients with acute hepatitis A who underwent US. The diagnosis of acute hepatitis A was made during acute illness by demonstrating anti- HAV of the IgM class. US images were reviewed simultaneously by two abdominal radiologists and a consensus was reached for GB wall thickening, GB collapse, lymphadenopathy, and hepatic echogenicity. The associations between demographic, clinical, biochemical, and US findings and GB wall thickening or collapse were then assessed. GB wall thickening was present in 123 (81%) and GB collapse in 96 (63%) of the 152 patients. Total bilirubin level and GB collapse differed significantly (p < 0.05) between patients with and without GB wall thickening. Gender ratio, total and peak total bilirubin level, and GB wall thickness differed significantly (p < 0.05) between patients with and without GB collapse. Multivariate analysis showed that GB wall thickening was associated with GB collapse and vice versa. GB wall thickening and GB collapse are common US abnormalities associated with each other in patients with acute hepatitis A. However, GB wall thickening or collapse is not associated with any demographic, clinical, or biochemical factors, or with other US findings, in patients with acute hepatitis A.
[en] Six cases of nonvisulization of the gallbladder lumen in patients with acute viral hepatitis are presented. Follow-up ultrasonographic examinations done during the convalescent period in 2 patients showed normal gallbladders and this was correlated with improvement in enzyme levels. It is suggested that acute viral hepatitis should be considered in the differential diagnosis of nonvisualization of the gallbladder lumen on sonogram.
[en] This study describes the first case of biliary peritonitis after radiofrequency ablation diagnosed by magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), a hepatocyte-specific MR imaging contrast agent. The image acquired 300 minutes after the administration of Gd-EOB-DTPA was useful to make a definite diagnosis and to identify the pathway of bile leakage. It is important to decide on the acquisition timing with consideration of the predicted location of bile duct injury.
[en] Obstructive jaundice related to stricture and stone in cystic duct was found in a patient 6 years after liver transplantation and cholecystojejunostomy. Complications with biliary drainage following liver transplantation are discussed. In the presence of dilated ducts seen by ultrasound, percutaneous transhepatic cholangiography performed immediately can lead to surgical correction, thus preventing failure of the liver transplant. (orig.)