Medicine and Health Sciences Commons^™

Hereditary Hemochromatosis., Om Parkash, Muhammad Akram

Department of Medicine

Objective: To describe the clinical and laboratory features of hereditary hemochromatosis associated liver disease in a tertiary care hospital.

Study Design: Observational study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2002 to October 2012.

Methodology: Charts of patients with Hereditary Hemochromatosis (HHC) were reviewed. Data collected and analyzedconsisting of clinical presentations, liver function tests, serum ferritin, transferrin saturation, hepatic imaging and histologyin patients with HHC.

Results: A total of 22 patients were identified as having hemochromatosis. All subjects were men with a mean age of 53 ± 9.2 years at the time of diagnosis. …

Pathogen-Specific Burdens Of Community Diarrhoea In Developing Countries: A Multisite Birth Cohort Study (Mal-Ed), Sadia Shakoor, Shahida Qureshi, Furqan Kabir, Anita K. M. Zaidi, Zulfiqar Ahmed Bhutta, Imran Ahmed, Didar Alam, Syed Asad Ali, Muneera Rasheed, Sajid Bashir Soofi, Ali Turab, Aisha Khizar Yousafzai

Department of Pathology and Laboratory Medicine

Background: Most studies of the causes of diarrhoea in low-income and middle-income countries have looked at severe disease in people presenting for care, and there are few estimates of pathogen-specific diarrhoea burdens in the community.
Methods: We undertook a birth cohort study with not only intensive community surveillance for diarrhoea but also routine collection of non-diarrhoeal stools from eight sites in South America, Africa, and Asia. We enrolled children within 17 days of birth, and diarrhoeal episodes (defined as maternal report of three or more loose stools in 24 h, or one loose stool with visible blood) were identified through …

Morbidity And Mortality Assessment In Acute Hepatitis-E., L. Kamani, Saeed Sadiq Hamid, Faisal Wasim Smail,, Syed Waqas Haider, Safia Awan, Ashfaq Ahmed, Wasim Jafri

Department of Medicine

Background: Hepatitis-E is an enterically transmitted virus causing acute hepatitis. Mostly it is a self-limiting clinical course, but can be life threatening in certain high risk groups. Pakistan is endemic for Hepatitis-E with limited published literature. The aim of this study is to evaluate the predictors of mortality in patients with acute Hepatitis-E.

Methods: We analyzed the medical records of 369 adult patients with Hepatitis-E infection admitted at Aga khan University Hospital, from January 1996 to December 2010. Details of their laboratory investigations, clinical course and complications such as FHF and mortality were noted. The outcome was compared, and determinants …

Hepatic Encephalopathy In Chronic Liver Disease: Predisposing Factors In A Developing Country, Fakhar Qazi, Shameem Behram Khan, Anam Umar

Section of Gastroenterology

Objective: To fi nd out the risk factors for developing Hepatic Encephalopathy in patients suffering from Chronic liver disease.

Background: Hepatic encephalopathy (HE) is a neuropsychiatric disorder that is caused by liver damage. In its pathology, alterations in normal brain function are associated with an increase in blood ammonia, benzodiazepine like substances, products of neurotoxic fatty acids, and other gut derived toxins, which gain access to the brain as a result of liver dysfunction.

Study Design: Hospital based descriptive, cross sectional study.

Settings: Medical Unit 1, Ward- 5, Jinnah Post Graduate Medical Centre, Karachi.

Duration: July 2013 to December 2013. …

Is It Time To Replace Propranolol With Carvedilol For Portal Hypertension?, Shahab Abid, Saadat Ali, Muhammad Asif Baig, Anam Akbar Waheed

Section of Gastroenterology

Beta-adrenergic receptor antagonists (beta-blockers) have been well established for use in portal hypertension for more than three decades. Different Non-selective beta-blockers like propranolol, nadolol, timolol, atenolol, metoprolol and carvedilol have been in clinical practice in patients with cirrhosis. Carvedilol has proven 2-4 times more potent than propranolol as a beta-receptor blocker in trials conducted testing its efficacy for heart failure. Whether the same effect extends to its potency in the reduction of portal venous pressures is a topic of on-going debate. The aim of this review is to compare the hemodynamic and clinical effects of carvedilol with propranolol, and attempt …

Interferon Lambda-3 Polymorphism And Response To Pegylated Interferon In Patients With Hepatitis D, Zaigham Abbas, Javed Yakoob, Muhammad A. Umer,, Minaam Abbas, Saeed Hamid

Section of Gastroenterology

Background: Specific single nucleotide polymorphisms (SNPs) near the interferon lambda-3 (IFNλ3) gene (formerly interleukin 28B) influence the response to treatment with interferon in hepatitis C patients. We aimed to investigate such an influence in hepatitis D patients.
Methods: The study population consisted of hepatitis D patients who were previously treated with pegylated interferon for one year and who were spontaneous clearers of the virus post recent superinfection. The SNP of IFNλ3, rs12979860, was determined by polymerase chain reaction-restriction fragment length polymorphism protocol.
Results: The total number of patients was 64; median age was 30.5 years and 53 were male. The …

Low Dose Albumin For The Prevention Of Renal Impairment Following Large Volume Paracentesis In Cirrhosis., Waqar Hussain, Abdullah Bin Khalid, Tayyab Usmani, Aiman Ghufran, Syed H Shah

Department of Medicine

OBJECTIVES: To evaluate the effect of low dose Albumin i.e. 4 grams per litre of ascitic fluid after large volume paracentesis (LVP) for the prevention of paracentesis induced circulatory dysfunction (PICD) related renal impairment in cirrhosis.

METHODS: Case records of all patients with cirrhosis who underwent LVP from January 12(th), 2011 till December 29(th), 2013 were reviewed. Patients were excluded if they had spontaneous bacterial peritonitis, creatinine >1.5 mg/dl, hepatoma or if volume of ascitic fluid removed was <5 litres. Data including age, gender, cause of cirrhosis, CTP score and volume of ascitic fluid drained were noted. In addition serum creatinine and serum sodium at baseline and one week post paracentesis were recorded.

RESULTS: Two hundred and fourteen patients with cirrhosis underwent LVP during the study period. One hundred and thirty nine patients met the …

Non-Invasive Parameters For The Detection Of Variceal Bleed In Patients Of Liver Cirrhosis, An Experience Of A Tertiary Care Hospital In Pakistan, Anam Umar, Fakhar Qazi, Rukhsana Abdul Sattar, Beena Umar

Section of Gastroenterology

Objective: Cirrhotic patients commonly undergo screening endoscopy for the existence of esophageal varices. The use of this invasive procedure which is expensive, poorly tolerable and generally not acceptable for the patients is increasing due to increasing number of patients with chronic liver disease and their enriched survival. In this study, our aim is to identify clinical, biochemical, and ultrasonography parameters which might noninvasively predict the presence of esophageal varices and risk of bleeding in patients with liver cirrhosis.

Material and Methods: Total 150 Patientsof chronic liver disease admitted in ward-5, JPMC(Sep 2011-Feb 2012) with a complaint of hematemesis or melena …