[en] To determine the efficacy of interferon-ribavirin therapy for chronic viral Hepatitis C (HCV) patients. Study Design: A quasi-experimental study. Place and Duration of Study: Medical Unit-III, Ward-7, Jinnah Postgraduate Medical Centre, Karachi, from August 2006 to December 2007. Methodology: Adult patients who had not received any prior anti-HCV therapy and had been infected with positive anti- HCV antibodies and detectable HCV RNA were enrolled in the study. Patients were excluded from the study if there was evidence of de compensated cirrhosis, coexistent HIV, or HBV infection, previous organ transplantation, psychiatric disease, seizure disorder, serious cardiovascular disease and other co-morbid diseases like uncontrolled Diabetes. Patients were given Interferon-alfa-2b 3 million international units three times a week sub-cutaneously and oral ribavirin at 1000-1200 mg in two to three divided doses a day for a 6-month period. At the end of treatment over all efficacy as depicted by non-detectable HCV RNA by PCR and its relation with factors of like age, gender, and serum ALT were assessed. Results: A total of 404 patients with mean age of 36.03+-9.30 years, ranging from 13 to 60 years, were offered combination therapy that satisfied the inclusion criteria. Among these, females were 243 (61.1%) and males were 161 (39.9%), age range 13-60 years with mean of 36.03 years. Out of 404, 336 (83.2%) showed response to combined interferon and ribavirin therapy depicted by HCV RNA by PCR at the end of 24 weeks treatment. Age under 40 years (p < 0.001) was significantly associated with favourable response. Conclusion: Combination therapy of interferon and ribavirin in chronic hepatitis C patients has still better response rate in our set-up. Younger age and female gender were the favourable predictors. (author)

[en] Objective: To determine the frequency of peripheral arterial disease (PAD) in type 2 diabetic patients. Study Design: Cross-sectional observational study. Place and Duration of Study: Diabetes Clinic, Medical Unit III, Jinnah Postgraduate Medical Centre, Karachi, from January to June 2010. Methodology:Three hundred and eighty seven (387) type II diabetic patients of either gender and any age were included. Patients with a previous history of trauma to the arterial vasculature, pregnancy and those who underwent in the study arterial graft procedures were excluded. Non-purposive convenient sampling technique was used to enroll patients in the study. PAD was diagnosed when ankle-brachial index (ABI) was less than 0.9. Ap-value of less than 0.05 was considered statistically significant. Results: Out of 387 studied patients, 128 were males (33.1%) and 259 were females (66.9%). Mean age was 52.22 +- 6.39 years. PAD was detected in 152 9.671 (22 - 76) years in the entire cohort. Mean duration of diabetes was 9.38 +- (39.28%) of the total study subjects. Thirty-one of 128 male patients (24.22%) had PAD disease while 121 out of 259 female patients (46.71%) had evidence of PAD (p = 0.001). Hypertension was a significantly associated factor (p = 0.002). Conclusion: A high frequency of PAD was observed in the diabetic population particularly with hypertension and more prevalent in females. (author)

[en] To determine the severity of thrombocytopenia in different grades of esophageal varices. Study Design: Cross-sectional analytical study. Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January to December 2008. Methodology: Subjects were eligible if they had a diagnosis of cirrhosis. Patient with advanced cirrhosis (Child-Pugh class C), human immunodeficiency virus (HIV) infection, hepatocellular carcinoma, portal vein thrombosis, parenteral drug addiction, current alcohol abuse and previous or current treatment with b-blockers, diuretics and other vasoactive drugs were excluded from the study. All patients under went upper gastrointestinal endoscopy after consent. On the basis of platelet count patients were divided into four groups. Group I with platelets greater or equal to 20000/mm/sup 3/, Group II with values of 21000- 50000/mm/sup 3/, Group III with count of 51000-99000/mm/sup 3/ and Group IV with count of 100000-150000/mm/sup 3/. Correlation of severity of thrombocytopenia with the grading of esophageal varices was assessed using Spearman's correlation with r-values of 0.01 considered significant. Results: One hundred and two patients with thrombocytopenia and esophageal varices were included in the study. There were 62 (60.8%) males and 40 (39.2%) females. The mean age of onset of the disease in these patients was 49.49 +- 14.3 years with range of 11-85 years. Major causes of cirrhosis were hepatitis C (n=79, 77.5%), hepatitis B (n=12, 11.8%), mixed hepatitis B and C infection (n=8, 7.8%) and Wilson's disease (n=3,2.9%). Seven patients had esophageal grade I, 24 had grade II, 35 had grade III, and 36 had grade IV. Gastric varices were detected in 2 patients. Portal hypertensive gastropathy were detected in 87 patients. There was an inverse correlation of platelet count with grading of esophageal varices (r=-0.321, p < 0.001). Conclusion: The severity of thrombocytopenia increased as the grading of esophageal varices increased. Thrombocytes count was significantly and inversely correlated with the grade of esophageal varices. (author)

[en] Objective: To find out the outcome og band ligation of oesophageal varices in decompensated chronic liver disease patients. Methods: The quasi experimental study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and Civil Hospital, Karachi, unit from September 2007 to August 2011. Subjects were eligible if they had a diagnosis of cirrhosis based on history, physical examination, biochemical parameters and liver biopsy in some cases. Patients with advanced cirrhosis (Child-Pugh class C), antibodies against human immunodeficiency virus, hepatocellular carcinoma, portal vein thrombosis evident on ultrasonography, parenteral drug addiction, current alcohol abuse, previous or current treatment with β-blockers were excluded from the study. All patients were asked about alcohol intake and tested to determine the cause of liver cirrhosis. Tests for other causes of cirrhosis were carried out only if there was a suggestive clue. All patients under-went upper gastrointestinal endoscopy after consent. SPSS 15 was used for statistical analysis. Results: The age of the 173 patients who met the inclusion criteria ranged from 15 to 85 years, with a mean of 48.39+-13.38 years. There were 112 (64.7%) males. High-grade varices were seen in 130 (75.1%) patients, while low-grade varices were observed in 43 (24.9%) on first endoscopy. At initial endoscopy, 111 (64.2%) patients had portal hypertensive gastropathy. The patients were followed up for a mean period of 5.20+-2.67 months. Variceal obliteration was achieved in 138 (79.8%), while 33 (19.1%) cases developed re-bleeding. Mean number of endoscopy sessions for these patients were 2.28+-.918 with a maximum of 4. Conclusion: Band ligation eradicated oesophageal varices with less complications and a lower re-bleeding rate, but at the same time eradication was associated with more frequent development of portal hypertensive gastropathy. (author)

[en] Objective: To determine the association of serum cholesterol levels with Child-Pugh class in patients with decompensated chronic liver disease due to viral hepatitis. Methodology: Consecutive patients attending outpatient department or admitted in medical unit III were eligible if they had a diagnosis of cirrhosis secondary to viral hepatitis. Patients were excluded if alcoholic, diabetic, hypertensive, or with non-alcoholic fatty liver disease, autoimmune, metabolic, cardiovascular, cerebrovascular or kidney diseases and recent use of lipid-regulating drugs. Serum lipid profile was determined after an overnight fast of 12 hours. On the basis of serum total cholesterol, patients were divided into four groups; Group I with serum total cholesterol = 100 mg/dl, Group II with level of 101-150 mg/dl, Group III with level of 151-200 mg/dl and Group IV with serum total cholesterol level of > 200 mg/dl. Hepatic dysfunction was categorized according to Child-Pugh scoring system. Chi-square and Spearman's correlation testing with p < 0.05 was accepted as significant. Results: One hundred and fourteen patients met the inclusion criteria with a mean age of 40.32 +- 13.59 years. Among these 32 were females (28.1%) while 82 were males (71.9%). According to Child-Pugh class; 34 patients (29.8%) presented with Child-Pugh class A, 34 (29.8%) in class B and 46 (40.4%) were in class C. Serum cholesterol (total) and triglycerides had significant association with Child-Pugh class (p = 0.0001 and p = 0.004 respectively) suggesting that as severity of liver dysfunction increases; serum cholesterol and triglycerides levels decrease. Results also revealed that males were significantly more hypocholesterolemic than females (p = 0.006). Conclusion: Hypocholesterolemia is a common finding in decompensated chronic liver disease and has got significant association with Child-Pugh class. It may increase the reliability of Child-Pugh classification in assessment of severity and prognosis in chronic liver disease patients. (author)

[en] Objective: To determine the frequency of portal hypertensive gastropathy (PHG) and its relation with biochemical, haematological and endoscopic findings in cirrhotic patients. Study Design: Cross-sectional analytical study. Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7, from June 2009 to December 2010. Methodology: Patients with diagnosis of cirrhosis and either undergoing screening upper gastrointestinal (GI) endoscopy or presented with acute upper GI bleeding were included in the study. Portal hypertensive gastropathy and oesophageal varices were classified using Baveno scoring system. The severity of cirrhosis was classified according to the Child-Pugh criteria. Hypersplenism was assessed by the reduction of haemoglobin, leucocytes and platelets. Results: Out of 217 patients, 148 were males (68.2%) and 69 were females (31.8%) with ages ranging from 15-85 years, (mean 48.06 years). There were 144 HCV +ve patients (66.4%), 36 HBV +ve patients (16.6%), 15 HCV/HBV co-infected patients (6.9%) and only 1 (0.5%) had co-infection of HBV/HDV. Twenty-one patients (9.7%) were classified as having cryptogenic cirrhosis. Out of 172 patients (79.27%), 56 patients (25.8%) had mild and 116 patients (53.5%) were suffering from severe PHG. Significant positive correlation was found between esophageal variceal grade and PHG (r=0.46, p < 0.001) but not with etiology (r=0.05, p=0.41) or hypersplenism (r=0.08, p=0.22). Conclusion: The frequency of PHG was 79.27% in the studied group. The grade of oesophageal varices had significant relation with PHG that is the severity of PHG increased with the grade of oesophageal varices, suggesting common pathophysiology of both entities. (author)

[en] To describe the clinico-pathological and radiological profile of hepatocellular carcinoma. All consecutive patients suspected of having hepatocellular carcinoma (HCC), were admitted and included in this study. Diagnosis of HCC was established by clinical, biochemical, ultrasonographic and histopathologic findings. Patients with primary carcinoma elsewhere in the body, metastatic in the liver, fibrolamellar carcinoma and benign tumours were excluded from the study. At ultrasonography, the details of tumour size and number, portal vein thrombosis and presence of ascites were recorded. Patients were staged according to Okuda staging system. Results were described in mean and percentage values. There were 82 patients with hepatocellular carcinoma including 58 males and 24 females, with male to female ratio of 2.8:1. The mean age of patients was 56.24 +- 13.65 years. Right hypochondrial pain was the main symptom in 52 (63.4%) patients. The duration of symptoms varied from 1 month to 2 years. Tumour size was larger than 50% of liver size in 42 (51.2%) with portal vein thrombosis in 10 (12.19%). Anti HCV was positive in 44 (53.7%), HBsAg in 26 (31.7%) and both were found positive in 2 (2.44%) patients. Ten patients (12.2/%) found negative both for anti-HCV and HBsAg. According to Okuda staging system 18 patients had stage 1, 50 had stage 2 and 14 had stage 3 hepatocellular carcinoma. The mean age of presentation of hepatocellular carcinoma was younger as compared to western countries with potentially large non-resectable lesions. Chronic hepatitis C and B was found to be the major known factors. Patients with chronic hepatitis C and B should undergo vigorous HCC surveillance to detect early, potentially respectable HCC. (author)

[en] Aim: To find out the demographic, clinical, laboratory and radiological spectrum of COVID-19 patients. Study design: Cross-sectional observational study. Place and duration of study: Al-Tibri Medical College Hospital, Isra University Karachi campus Karachi from June 2021 to December 2021. Methodology: The study enrolled adult patients of both genders with COVID-19 infection confirmed through positive qualitative RT‑ PCR from nasal swab. After obtaining informed consent each confirmed patient with COVID-19 disease underwent a process of detailed medical history, clinical examination, laboratory tests, and radiological assessment. Based on presentation patients were divided into three groups; Group I, asymptomatic patients having only positive for COVID 19 were advised for self-isolation at home, Group 2 patients with mild symptoms and admitted to ward for observation and monitoring, while Group 3 were patients with moderate to severe disease and requiring intensive care. Results: A total of 179 patients with a mean age of 49.218±13.237 years (rang 18 to 85 years) were enrolled in the study with gender based presentation 51 (28.5%) were women and 128 (71.5%) were men. Clinically; main symptoms were fever in 155 (86.6%), shortness of breath 129(72.1%), cough 126 (70.39%), and body ache in 104 (58.1%). Twenty six (14.5%) patients were asymptomatic (Group I), 107(59.8%) were symptomatic mild disease (Group II) and 37 (20.7%) patients presented with moderate to severe symptomatic illness (Group III). The majority of study participants 140 (78.21%) have various comorbidities, DM 60(33.5%), hypertension in 61(34.1%). Conclusion: Our study has highlighted the variability of most aspects of COVID-19 and this might be the main reason why the spectrum of the disease cannot be predicted. Radiologic, pulmonary with clinical patterns are relatively specific but extra pulmonary involvement especially hepatic may misguide and worse the prognosis. (author)