Isolated pancreatic tuberculosis (TB) remains a rarity despite the high incidence of tuberculosis in many of the African and Asian countries. Presentation as discrete pancreatic mass often masquerades as pancreatic neoplasm and diagnosis may require histology. Extra-hepatic portal hypertension due to splenic vein thrombosis complicating pancreatic TB has been reported in the literature. We report here a case of isolated pancreatic TB with pancreatic head mass mimicking neoplasm with extra-hepatic portal hypertension. The possibility of TB should be considered in the list of differential diagnoses of pancreatic mass and an endoscopic, ultrasound-guided biopsy might help to clinch the diagnosis of this potentially curable disease.

Bleeding manifestations, usually cutaneous or gastrointestinal - are common in liver cirrhosis. Spontaneous intracerebral and intramuscular bleeds are reported uncommonly, often associated with gross hepatic dysfunction and severely deranged hemostatic parameters, and are often markers to imminent mortality. Male sex, alcoholic etiology, significant thrombocytopenia, severe coagulopathy, and advanced liver disease are common denominators in patients with spontaneous intramuscular bleed. We here report three cases of spontaneous muscle hematomas complicating hepatic cirrhosis. To the best of our knowledge, this is the largest single center series reporting spontaneous muscle hematomas complicating cirrhosis from the Indian subcontinent.

Background: Serum HBV DNA is a useful and reliable marker to diagnose and monitor CHB on treatment. The limitation of HBV DNA is that it is expensive and that the assays lack uniformity and standardization. Hence there is a need for more economical and reliable marker. HBsAg quantitation is one such surrogate serological marker. The objective of the current study is to compare and correlate the serum hepatitis B DNA quantitative PCR with HBsAg quantitation.Methods: Patients with CHB attending to the outpatient clinic of Gastroenterology department were enrolled in the study. Patients with undetectable HBV DNA levels and those co-infected with HCV or HIV were excluded from the study. All patients were tested for serological markers like HBsAg (rapid), HBeAg, anti HBe and HBV DNA-PCR. HBsAg quantification was done using conventional ELISA immunoassay. HBV-DNA and qHBsAg levels were expressed in log10IU/ml. Pearson correlation was used to estimate correlation between HBV DNA and HBsAg quantitation. Statistical analysis was done using SPSS and P value of <0.05 was considered significant.Results: A total of 38 patients were enrolled in the study. 23.62% were females and mean age of patients in the entire study group was 35.72 years. The mean ALT level was 103.80U/L. 26.32% (n = 10) were HBeAg positive. Mean HBV DNA and qHBsAg levels for the entire cohort were 5.81 log10IU/ml and 5.83 log10IU/ml respectively with a correlation coefficient of 0.318 (P = 0.130). For HBeAg positive patients the mean HBV DNA and qHBsAg levels were 7.90 log10IU/ml and 5.91 log10IU/ml respectively with a correlation coefficient of 0.722 (P = 0.043). HBV DNA levels were significantly higher in HBeAg positive patients compared with HBeAg negative patients (7.9 versus 4.01; P = 0.002). qHBsAg levels were also marginally high in HBeAg positive patients (5.91 versus 5.8; P = 0.136). Neither HBV DNA levels nor qHBsAg levels correlated with serum ALT levels.Conclusions: There is a significant correlation between quantitative HBsAg levels and HBV-DNA levels in HBeAg positive patients with chronic hepatitis B but not in HBeAg negative patients. HBV-DNA levels are significantly higher in HBeAg positive patients.

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