267 patients of chronic liver disease (CLD) who presented with upper GI bleed (hematemesis or melena) were included in this study. Before the endoscopic procedures, patients were clinically evaluated by gastroenterology fellows at the time of patient's presentation. Upper GI endoscopy was performed within 48 hours in all hemodynamically stable patients. Results: The average age of the patients was 44.27±12.13 years. Frequency of non variceal upper gastrointestinal bleeding (NVUGIB) in the patients of chronic liver disease was 56.93% (152/167). Conclusion: It is concluded that current magnitude of NVUGIB is very high in cirrhotic patients therefore adequate planning and knowledge of the specific mechanisms explaining the prognostic factors of NVUGIB to prevent it and thereby reducing the morbidity and mortality in Chronic Liver Disease.
Celiac disease is a small bowel disorder, due to defect in gluten diet, leading to mucosal inflammation, villous atrophy and crypt hyperplasia. For the diagnosis of celiac disease, one has to be on gluten free diet. Due to commonly available various serologic tests and histopathology, celiac disease, can be categorized as asymptomatic, silent or potential. Between 80 and 90% of all patients with celiac disease remained undiagnosed. Because of this late diagnosis, patients may develop various complications including anemia, bone loss, depression and cancers. Patients may have different types of anemia including iron deficiency, folic acid or B12 deficiency. Any of these may occurred separately or may be manifested together. The same variation is seen in bone loss, starting from osteopenia, osteomalacia to osteoporosis and even dysplasias. Patient may develop lymphoma, gastric or oesophageal carcinomas as well. Celiac disease is also associated with other autoimmune illnesses as it is an autoimmune process by itself. The complications of celiac disease, is either due to direct consequence of celiac, or due to significant damage to the small intestine. With the early detection and diagnosis, the symptomatology and complications of celiac disease can be spared.
Objectives: To determine the prevalence of diabetes mellitus and pre-diabetes among patients with NAFLD having BMI ≥ 25 kg/m2and compare it with the control group with non-fatty liver with same BMI. Study Design: Prospective, Analytical and Cross-sectional study. Setting: Department of Medicine, Civil Hospital Karachi. Period: January 2015 to October 2016. Material & Methods: The study was conducted among two groups of patients, one with non-alcoholic fatty liver disease (NAFLD), having BMI of ≥25kg/m2and they were compared with a control group having BMI≥25kg/m2 but without fatty liver on ultrasound. Result: Out of 201 NAFLD participants, 82.08% had pre-diabetes and diabetes mellitus, while 82.51% of participants from non-NAFLD (n=101) had pre-diabetes or diabetes mellitus. Insulin resistance was more common among non-NAFLD group than NAFLD group. Most of the metabolic parameter analysed in the study among two groups having slight difference, and they were statistically significant. Conclusion: Pre-diabetes and diabetes mellitus is a frequently reported problem among NAFLD and overweight/obese patients. Insulin resistance was found to be a significant predictor of diabetes mellitus.
Objectives: Determine the status of immunity against the hepatitis B virus amongvaccinated hemodialysis patients at a tertiary care hospital. Study Design: Cross sectionalstudy. Place and Duration of Study: All medical wards of Civil Hospital and Ojha campus, DowUniversity of Health Sciences, Karachi, Pakistan from May 2013 to January 2015. Methodology:Patients with chronic kidney disease on hemodialysis attending out-patient department wereenrolled. Patients with either gender and aged 18-70 years, who give consent for participation,who are on HD for more than 9 months with a proven diagnosis of ESRD who have receiveda complete course of 4 doses of hepatitis B vaccination atleast 2 months back were includedin this study. Non-consenting patients, present/past history of viral hepatitis, patients whowere hepatitis B surface antigen (HBsAg) positive, patients on immunosuppressive agents,pregnant patients were excluded from this study. Results: Out of the 103 patients, 69 (67%)males and 34 (33%) females with mean age of study population was 51.1 ± 14.3 years (17 to70 years), mean duration post vaccination was 7.6 ± 0.9 months (6 to 9 months), mean antiHBs antibody level was 184.6 ± 293.4 (level rang 0 to 1000) and mean hemodialysis durationwas 26.4 ± 12 months (10 to 50 month). Out of 37 non-responders 28 (75.7%) had twice weeklyschedule of hemodialysis and 09 (24.3%) had thrice weekly schedule of hemodialysis, out of 19weak responders 13 (68.4%) had twice weekly schedule of hemodialysis and 06 (31.6%) hadthrice weekly schedule of hemodialysis and out of 47 high responders 29 (61.7%) had twiceweekly schedule of hemodialysis and 18 (38.3%) had thrice weekly schedule of hemodialysis(p=0.395). Conclusion: Excellent response of HbsAg B vaccination for those patients, undergodialysis procedure that is not associated with age, systemic inflammation or nutritional. Effectivedialysis procedure associated with excellent response to the vaccine hepatitis B.
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