Gastroenterology Commons^™

Itopride For Gastric Volume, Gastric Emptying And Drinking Capacity In Functional Dyspepsia, Shahab Abid, Wasim Jafri, Maseeh Uz Zaman, Rakhshanda Bilal, Safia Awan, Aamir Abbas

Section of Gastroenterology

AIM: To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia (FD).

Methods: Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacityof tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. ¹³C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink …

Role Of Assessment For Retreatment With Transarterial Chemoembolization Score In Decision Of Retreatment With Trans-Arterial Chemo-Embolization Sessions In Patients With Hepatocellular Carcinoma, Anwar Hussain Abbasi, Shahab Abid, Tanveer Ul Haq, Safia Awan

Department of Family Medicine

Background: The objective behind this study was to determine that Assessment for Retreatment with Transarterial chemoembolization (ART) score is really applicable in patients with hepatocellular carcinoma.
Methods: A cross sectional observational study was conducted on all patients with hepatocellular carcinoma of intermediate stage and undergone ≥2 Transarterial chemoembolization. ART score was assessed before and after each session of Transarterial chemoembolization. Multi-logistic regression analysis was performed to compare the final outcome of patients with ART score of ≥2.5 into groups with two and more than two Trans-arterial chemo-embolization sessions.
Results: A total of 100 HCC patients were recruited for final analysis. …

Changes In Serum Lipid Profile Among Patients Suffering From Chronic Liver Disease Secondary To Hepatitis C, Fakhar Qazi, Shameem Behram Khan, Anam Umar, Noor Ul Saba Shaikh, Fizza Choudhry

Section of Gastroenterology

Objective: To find out the changes in lipid metabolism among patients suffering from chronic liver disease secondary to hepatitis C.

Study Design: Hospital based observational study.

Setting: Medical Unit-I, Ward–5, Jinnah Postgraduate Medical Centre, Karachi.

Duration: July 2013 to December 2013.

Patients and Methods: About 110 patients admitted in Medical Unit-I with a diagnosis of chronic liver disease were included in the study. Patients suffering from DM, HTN, CKD were excluded from the study. Fasting lipid profile was done in all cases.

Results and Observations: There were 44 (40%) male and 66 (60%) female patients. Mean age of the patients …

Immunomodulatory Effects Of Psyllium Extract On Helicobacter Pylori Interaction With Gastric Epithelial Cells., Javed Yakoob, Wasim Jafri, Malik Hassan Mehmood, Z Abbas, Kanwal Tariq

Section of Gastroenterology

Natural plant product Psyllium has anti-inflammatory activity that can modulate the function of cytokines. We determined the effect of Psylliumhusk extract on interleukin (IL)-8 and NF-κB secretion by gastric epithelial cells in response to Helicobacter pylori Human gastricadenocarcinoma cell line (AGS) cells were pretreated with Psyllium extract in different concentrations before H pylori infection. Cell culture supernatant was analyzed for IL-8 and NF-κB by ELISA. RNA from cells was used for real-time polymerase chain reaction for messenger RNA expression of IL-8. Psyllium extract 5 and 10 μg/mL markedly (P < .001) lowered basal IL-8 by 64.71% and 74.51%, respectively, and H pylori-stimulated IL-8 was also (P < .001) lowered by 41.67% and 66.67%, respectively. Psyllium 5 and 10 μg/mL also reduced (P < .0001) cagA-positive H pylori-induced IL-8 mRNA expression by 42.3% and 67.6%, respectively. Psyllium also reduced (P = .0001) NF-κB in response to H pylori strains confirming its role as an anti-inflammatory agent.

Interferon Lambda-3 Rs12979860 Variants And Response To Pegylated Interferon In Chronic Hepatitis-C Genotype-3, Zaigham Abbas, Javed Yakoob, Muhammad A. Umer, Ali A. Azeem, Saeed S. Hamid, Wasim Jafri

Department of Medicine

Objective: To assess the role of single nucleotide polymorphisms (SNPs) near the interferon lambda-3 (IFNλ3) (formal IL-28B) gene rs12979860 in predicting sustained virologic response (SVR) in hepatitis-C virus genotype-3 (HCV-3).

Study Design: Descriptive, analytical study.

Place and Duration of Study: Department of Medicine, The Aga Khan University Hospital, Karachi, from July 2012 to June 2014.

Methodology: Patients with HCV-3 were classified as sustained virologic response (SVR), relapsers and non-responders. SNP rs12979860 was determined by PCR-RFLP protocol. Differences between categorical variables were assessed by chi-square or Fisher's exact test, while those between continuous variables were evaluated using the Mann-Whitney U-test. Binary …

Next Big Threat For Pakistan Hepatocellular Carcinoma (Hcc), Om Parkash, Saeed Hamid

Section of Gastroenterology

In our country, world hepatitis day (28th May 2013) was observed as a liver cancer day to draw global attention on the global health menace caused by Hepatocellular carcinoma (HCC). This is the right time to write a review article to apprise the nation of this growing burden of HCC caused most commonly by viruses in our country. Pakistan is also recognized as one of the countries of the world where hepatitis C virus (HCV) is endemic. Recent large national surveys suggest an overall HCV prevalence of 4.8% and that of HBV as 2.5%. There are however communities where the …

Professional Practices Promoting Health Of Healthcare Workers: Comparison Of Public And Private Hospitals In Pakistan, Nourin Jivany, Javed Yakoob, Shazia Bana, Asima Faisa, Humeira Jawed

Section of Gastroenterology

Background and Objectives: Health and safety of healthcare workers (HCWs) is a determinant of the quality of healthcare delivered to the population at large. This study aimed at comparing various dimension of HCWs’ health and safety between public and private hospitals (PHs) in the Pakistan context.

Methods: A sample of 1146 HCWs from 2 public and 2 PHls in a metropolitan city were invited to response to a structured questionnaire, assessing various aspects of health and safety promotion practices in their hospital. Categorical data were compared using chi-square test or Fisher exact test or likelihood ratio tests.

Findings: According to …

Norovirus Infection And Acquired Immunity In 8 Countries: Results From The Mal-Ed Study, Furqan Kabir, Adil Kalam, Pascal Bessong Pascal Bessong, Zulfiqar Ahmed Bhutta, Anita K. M. Zaidi, (Mal-Ed) Network Investigators, Imran Ahmed, Didar Alam, Syed Asad Ali, Shahida Qureshi, Muneera Rasheed, Sajid Bashir Soofi, Ali Turab, Aisha Khizar Yousafzai

Department of Paediatrics and Child Health

Background: Norovirus is an important cause of childhood diarrhea. We present data from a longitudinal, multicountry study describing norovirus epidemiology during the first 2 years of life.
Methods: A birth cohort of 1457 children across 8 countries contributed 7077 diarrheal stools for norovirus testing. A subset of 199 children contributed additional asymptomatic samples (2307) and diarrheal stools (770), which were used to derive incidence rates and evaluate evidence for acquired immunity.
Results: Across sites, 89% of children experienced at least 1 norovirus infection before 24 months, and 22.7% of all diarrheal stools were norovirus positive. Severity of norovirus-positive diarrhea was …

Primary Hepatic Carcinoid Tumor With Poor Outcome, Om Parkash, Adil Ayub, Buria Naeem, Sehrish Najam, Zubair Ahmed, Wasim Jafri, Saeed Hamid

Section of Gastroenterology

Primary Hepatic Carcinoid Tumor (PHCT) represents an extremely rare clinical entity with only a few cases reported to date. These tumors are rarely associated with metastasis and surgical resection is usually curative. Herein, we report two cases of PHCT associated with poor outcomes due to late diagnosis. Both cases presented late with non-specific symptoms. One patient presented after a 2-week history of symptoms and the second case had a longstanding two years symptomatic interval during which he remained undiagnosed and not properly worked up. Both these cases were diagnosed with hepatic carcinoid tumor, which originates from neuroendocrine cells. Case 1 …

Understanding Health Seeking Behavior Of Health Care Professionals In Tertiary Care Hospitals In Pakistan, Shazia Bana,, Javed Yakoob, Nourin Jivany, Asima Faisal, Humeira Jawed, Safia Awan

Section of Gastroenterology

Background: Health seeking behaviour refers to the behaviour of people towards seeking their own health through provided health services. The medical professionals are at a higher risk of avoiding health seeking behaviour because they believe they are aware of the diseases and their symptoms as well as the pharmaceutical management of the disease. The aim of this study was to understand the healthcare seeking behaviour of nurses and doctors as well as the factors affecting it in hospitals of a major city in a developing country. Methods: A cross-sectional study was designed and a self-report questionnaire was distributed to …

Genomic Diversity Of Epec Associated With Clinical Presentations Of Differing Severity, Tracy H. Hazen, Michael S. Donnenberg, Sandra Panchalingam, Martin Antonio, Anowar Hossain, Inacio Mandomando, John Benjamin Ochieng, Shahida Qureshi, Farheen Quadri, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Enteropathogenic Escherichia coli (EPEC) are diarrhoeagenic E. coli, and are a significant cause of gastrointestinal illness among young children in developing countries. Typical EPEC are identified by the presence of the bundle-forming pilus encoded by a virulence plasmid, which has been linked to an increased severity of illness, while atypical EPEC lack this feature. Comparative genomics of 70 total EPEC from lethal (LI), non-lethal symptomatic (NSI) or asymptomatic (AI) cases of diarrhoeal illness in children enrolled in the Global Enteric Multicenter Study was used to investigate the genomic differences in EPEC isolates obtained from individuals with various clinical outcomes. A …

Clinical Practice Guidelines On The Management Of Variceal Bleeding, Javed Iqbal Farooqi, Hasnain Ali Shah, Anwaar A. Khan, Amjad Salamat, Altaf Alam, Abbas Khan Khattak, Nazish Butt, Muhammed Salih, Sher Sher Rehman, Arif Amir Nawaz, Nasir Khokhar, Ghias-Un-Nabi Tayyab, Javed Aslam Butt, Kashif Malik, Shakeel Ahmad Mirza, Mohammad Akram

Department of Medicine

Gastroesophageal variceal bleeding occurs in 30 - 50% of patients of liver cirrhosis with portal hypertension, with 20-70% mortality in one year. Therefore, it is essential to screen these patients for varices and prevent first episode of bleeding by treating them with β-blockers or endoscopic variceal band ligation. Ideally, the patients with variceal bleeding should be treated in a unit where the personnel are familiar with the management of such patients and where routine therapeutic interventions can be undertaken. Proper management of such patients include: initial assessment, resuscitation, blood volume replacement, vasoactive agents, prevention of associated complications such as bacterial …

Electrophysiological Changes In Patients With Liver Cirrhosis In A Tertiary Care Hospital In Karachi, Pakistan, Om Parkash, Ghulam Rehman Mohyuddin, Adil Ayub, Irfan Nazir, Arslan Arif Maan, Saeed Hamid

Section of Gastroenterology

Background: Electrophysiological changes in cirrhosis are well known but least investigated especially in our country hence we wanted to see electrophysiological changes especially QT interval in cirrhotic patients.

Methods: A cross-sectional study was conducted at Aga Khan University Hospital Karachi (AKUH) in which medical records (duration 2008-2010) of cirrhotic patients were reviewed.

Results: Three hundred and eighty cirrhotic patients' charts were studied, 227 (59.7 %) were male and mean age of this cohort was 52.8±12.6 years. The most common cause for CLD was Hepatitis C (CHC) in 260 (68.4%), NBNC in 56(14.7%) and HBV in 51 (13.4%). Only 225 …

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, Lubna Kamani, Saeed Sadiq Hamid, Faisal Wasim Ismail, 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 …

Outcomes Of Splenectomy For Idiopathic Thrombocytopenic Purpura In Adults: A Developing Country Perspective., Amyn Pardhan, Aamir Hameed, Hasnain Zafar, Samia Mazahir, Ghulam Murtaza

Department of Medicine

Objective: to determine the outcome of splenectomy done in adult patients of Idiopathic Thrombocytopenic Purpura over a period of 10 years and, secondarily, to determine the predictors of complete response to therapy.

Methods: The retrospective review comprised of adult patients over 14 years of age who underwent open or laparoscopic splenectomy for Idiopathic Thrombocytopenic Purpura at Aga Khan University Hospital, Karachi, from January 2000 to December 2010. Data was reviewed in January 2011 by a surgical resident. Outcome was the response to splenectomy as per new definition of response set by the American Society of Haematology 2011 evidence based practice …

Agreement Between Serology And Histology For Detection Of Helicobacter Pylori Infection, Javed Yakoob, Zaigham Abbas

Section of Gastroenterology

No abstract provided.

Age And Site Of Colonic Neoplastic Lesions: Implications Of Screening In South Asia., Manzoor Hussain, A. B. Khalid, Syed Ahsan Ali, Wasim Jafri, Saeed Hamid, Anam Javed, Sana Wahab

Department of Medicine

Objective : To evaluate the Age of patients and the site of Colonic Neoplastic Lesions (CNL) and to determine the appropriate screening strategy for Colorectal Carcinoma (CRC) (sigmoidoscopy versus colonoscopy) in our population.

Methods : This is a cross sectional study. Data of all patients more than 16 years of age who underwent full colonoscopic examination at the Aga Khan University hospital between January 2011 till December 2013 and were diagnosed to have CRC or advanced adenomas (defined as polyp more than 1 cm and/or having villous morphology on histology) was recorded. Lesions found distal to the splenic flexure were …

Cytokine Changes In Colonic Mucosa Associated With Blastocystis Spp. Subtypes 1 And 3 In Diarrhoea-Predominant Irritable Bowel Syndrome, Javed Yakoob, Zaigham Abbas, Muhammad Waqas Usman, Aisha Sultana, Muhammad Islam, Safia Awan, Zubair Ahmad, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

We determined cytokines (e.g. interleukin-8, 10, 12 and TNF-α) expression by peripheral blood mononuclear cells (PBMCs) and in rectal mucosa in diarrhoea-predominant irritable bowel syndrome (D-IBS) with Blastocystis spp. Eighty patients with D-IBS and Blastocystis spp. infection were classified as 'cases' and 80 with D-IBS without Blastocystis spp. infection were classified as 'control'. Cases were subdivided into D-IBS and Blastocystis sp. defined type 1 (subtype-specific primer SB83) and type 3 (SB227). Stool microscopy and culture were performed. Rectal biopsies were obtained for histology and cytokines by real-time PCR for mRNA expression of cytokines. PBMCs IL-8 was similar in different groups …

Refeeding Syndrome In A Young Girl With Anorexia Nervosa., Om Parkash, Adil Ayub, Shahab Abid

Department of Medicine

We report the case of a 20-year-old anorexic girl (BMI=12.9), who was misdiagnosed the first time and developed severe electrolyte imbalances due to lack of awareness about refeeding syndrome. Few cases of RS have been reported in literature and protocols have been suggested for prevention and management of this syndrome, including the awareness of circumstances in which it is most likely to develop, refeeding slowly and building-up micronutrient content over several days. Improved awareness and understanding of refeeding syndrome along with a well-coordinated plan are vital in delivering safe and effective nutritional rehabilitation. We suggest a slow and gradual increase …

Knowledge, Attitude And Practices Regarding Hiv/Aids Among Adult Fishermen In Coastal Areas Of Karachi., Mubashir Zafar, Nighat Nisar, Masood Kadir, Zafar Fatmi, Zeeshan Ahmed, Kashif Shafique

Community Health Sciences

BACKGROUND:

Migrant populations are at high risk of Human Immuno Deficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS). Studies of HIV/AIDS knowledge, attitudes and practices among fishermen in developing countries have shown gaps in knowledge and fear of contagion with ambivalent attitudes towards HIV/AIDS and inconsistent universal precautions adherence. The aim of this study was to determine the knowledge, attitude and practices regarding HIV/AIDS among adult fishermen in a coastal area of Karachi, Pakistan.

METHODS:

Community based cross sectional study was conducted among fishermen in coastal area of Karachi from June to September 2012. A total of 297 adult …

Effect Of Helicobacter Pylori And Its Virulence Factors On Portal Hypertensive Gastropathy And Interleukin (Il)-8, Il-10, And Tumor Necrosis Factor-Alpha Levels, Zaigham Abbas, Javed Yakoob, Muhammad Waqas Usman, Tanzila Shakir, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Background/Aim: We aimed to assess the influence of Helicobacter pylori and its virulent factors, cytotoxin associated gene (cag) A and E, on portal hypertensive gastropathy (PHG) and the levels of interleukin (IL)-8, IL-10, and tumor necrosis factor-alpha (TNF-α).
Patients and Methods: The patients with cirrhosis underwent screening endoscopy and the lesions related to PHG were graded. Biopsies were obtained for histology, and polymerase chain reaction (PCR) of H. pylori 16S rRNA, cagA, cagE, and tissue cytokine levelswas carried out. Absent or mild PHG was compared with moderate to severe PHG.
Results: One hundred and forty patients with cirrhosis were studied; …

Treatment Of Chronic Hepatitis D Patients With Pegylated Interferon: A Real-World Experience, Zaigham Abbas, Mohammad S. Memon, Hammad Mithani, Wasim Jafri, Saeed Hamid

Section of Gastroenterology

Background: Published experience of treating chronic hepatitis D patients with pegylated interferon (PEG-IFN)-alpha is limited. The aim of this study was to determine the efficacy of 48 weeks of treatment with PEG-IFN in naive patients outside the clinical trial setting, in the real world.

Methods: Patients with chronic hepatitis D were treated with PEG-IFN. The primary end points were sustained clearance of HDV RNA and normal alanine aminotransferase (ALT) at 24 weeks post-treatment.

Results: The total number of patients treated with PEG-IFN was 104; 91 males, mean age ±SD 30.1 ±10.0 years (range 15-55). Cirrhosis was present in …

Salmonella Cholecystitis: Atypical Presentation Of A Typical Condition, Rehan Ali, Shakeel Ahmed, Maqbool Qadir, Huba Atiq, Muhammad Hamid

Department of Emergency Medicine

Salmonella cholecystitis is a rare but important complication of Salmonella typhi infection. We are reporting an 11 years old female child who presented with complaints of high-grade fever, jaundice and right sided abdominal pain (Charcot's triad). Her examination showed tender hepatomegaly. Initial blood results revealed high white cell counts with left shift, deranged liver function tests. Abdominal ultrasonography revealed distended gallbladder with minimal layer of sludge seen within its lumen along with streak of pericholecystic fluid. Blood culture grew Salmonella typhi. She was successfully treated with intravenous ceftriaxone.