Entamoeba species associated with chronic diarrhoea in Pakistan

We determined the prevalence of Entamoeba (E.) histolytica, E. dispar and E. moshkovskii in patients with chronic diarrhoea associated with abdominal pain or discomfort mimicking irritable bowel syndrome. Stool samples were collected from 161 patients with chronic diarrhoea and from 157 healthy controls. Stool microscopy with modified trichrome stain, culture and polymerase chain reaction (PCR) for Entamoeba spp. differentiation was performed. Microscopy demonstrated Entamoeba cysts in 44% (57/129) of patients with diarrhoea compared to 29% (44/151) of controls (P=0·009). In patients with diarrhoea, PCR for E. histolytica was positive in 9% (11/129) (P=0·008), E. dispar in 19% (24/129) (P=0·117) and E. moshkovskii in 19% (24/129) (P\u3c0·001). E. histolytica and E. moshkovskii were significantly associated with diarrhoea while E. dispar was found equally in both groups

Model for end-stage liver disease (MELD) score as a useful prognostic marker in cirrhotic patients with infection

OBJECTIVE: To determine the association of Model for End stage liver disease (MELD) score to the outcome of cirrhotic patients with bacterial infection and to compare it with Child-Turcott-Pugh (CTP) score. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007. METHODOLOGY: Patients with diagnosis of liver cirrhosis and bacterial infection were included. Demographic features, laboratory data and type of infection were recorded. Multiple logistic regression assays were applied to determine the factors associated with poor outcome in cirrhotics with infection. Receiver-Operating Characteristics (ROC) were used to determine the cut-off values of CTP score and MELD score with the best sensitivity and specificity. RESULTS: A total of 530 patients, 313 male (59%) with a mean age of 53 +/- 13 years were analyzed. Spontaneous bacterial peritonitis was the predominant infection seen in 369 (69%) patients. One hundred and eighty six (35%) patients died. Factors associated with poor outcome were a CTP score of more than 11 (p=0.001), raised blood urea nitrogen (p=0.020), raised creatinine (p=0.004), shock (p=0.002), and MELD score \u3e 22 (p=0.03). An eight percent increase in mortality rate was noticed with every one point rise in MELD score above 22. ROC curve showed that the specificity of CTP and MELD score to predict poor outcome in these patients was 36% and 59% respectively. CONCLUSION: Child-Turcott-Pugh score more than 11, raised BUN and creatinine, shock and high MELD score were poor prognostic markers in cirrhotic patients with infection. MELD score had better specificity than CTP score in determining outcome

Nutritional status in patients with Hepatitis C

OBJECTIVE: To assess the nutritional status via the SGA (subjective global assessment) screening tool of patients at all stages of hepatitis C virus (HCV) liver disease. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Out-patient Clinics of the Aga Khan University Hospital, Karachi, conducted from October 2009 to January 2011. METHODOLOGY: Patients with hepatitis C virus infection and their HCV-negative attendants were enrolled from the outpatient clinics, and categorized into 4 groups of 100 patients each: healthy controls (HC), those with chronic hepatitis C infection (CHC), compensated cirrhotics (CC) and decompensated cirrhotics (DC). The validated subjective global assessment (SGA) tool was used to assess nutritional status. RESULTS: A total of 400 patients were enrolled. Most of the patients in the HC group were class \u27A\u27 (best nutritional status). In contrast, the majority (64%) in the DC group were in the class \u27C\u27 (worst status). The compensated cirrhosis (CC) group showed that 90% of patients were malnourished, while 98% of all patients were malnourished in the DC group, predominantly class \u27C\u27. Most importantly, 14% of patients with chronic hepatitis C (CHC) also scored a \u27B\u27 on the SGA; which when compared to HC was statistically significant (p=0.005). As the groups progressed in their disease from CHC to DC, the transition in nutritional status from \u27A\u27 to \u27C\u27 between groups was statistically significant. CONCLUSION: Malnutrition occurs early in the course of HCV, and progresses relentlessly throughout the spectrum of HCVdisease

Anti-Helicobacter pylori activity and inhibition of Helicobacter pylori-induced release of IL-8 in AGS cells by plant extracts

Plants used in popular diet were studied for anti-Helicobacter pylori activity and their effect on the expression of interleukin-8 (IL-8) from H. pylori infected gastric epithelial cells. Extracts were prepared of Allium sativum (A. sativum), Cuminum cyminum (C. cyminum),Piper nigrum (P. nigrum) and their mix in two different dilutions. AGS cell line and H. pyloristrains were used for co-culture experiments. Extracts bactericidal activity was determined by a viable colony count. ELISA (Enzyme linked immunosorbent assay) was used to determine IL-8 expression. DNA extracted from bacterial cells was used for polymerase chain reaction (PCR) of cytotoxin-associated gene (cagA) and E (cagE). Results revealedH. pylori strains sensitivity to A. sativum (5.5 mg/ml) was 57% (39/69) (p=0.06), and to 11 mg/ml was 65% (45/69) (p=0.02) compared to amoxicillin, respectively. CagE positive H. pylori, 37% (11/30) (p=0.02) were sensitive to plant mixture (23.5 mg/ml), 60% (18/30) (pC. cyminum (PP. nigrum (P=0.0046) and A. sativum(P=0.0021), respectively compared to positive and negative controls. Thus, dietary plants demonstrated an anti-H. pylori effect. They reduced IL-8 expression from the H. pyloriinfected AGS cells. Key words: Helicobacter pylori; Allium sativum, Cuminum cyminum, Piper nigrum, gastric epithelial cells, interleukin-8, ELISA, cagA, cagE

Perception and knowledge about dietary intake in patients with liver cirrhosis and its relationship with the level of education

Objective: To determine patients perception and knowledge regarding diet in cirrhosis and its relationship with the level of patients education. Study Design: Cross-sectional observational study. Place and Duration of Study: This study was conducted at Gastroenterology Outpatient Clinics at the Aga Khan University Hospital, Karachi, the Aga Khan Health Services, Malir, Karachi and Hamdard University, Karachi, from January to December 2010. Methodology: Consecutive adult patients with compensated cirrhosis were enrolled. Demographic data, level of education, type and reason of food restriction as well as the source of dietary information was asked. Baseline laboratory test were performed, and nutritional status was assessed by BMI normogram. Results: Ninety patients, 58% male were enrolled. Mean age of the patient was 49 11 years. Overall 73% of the patients were restricting fat, meat, fish and eggs in their diet; 53% were in uneducated group and 47% were in educated group (CI, 0.24-1.62, p-0.34). Twenty two patients (62.8%) in uneducated and 21 in educated group (68%) were restricting diet on the advice of their doctors, whereas 13 in uneducated group (37%) and 11 in educated group (32%) believed these dietary components to be harmful for the liver. Thirty two of uneducated patient (71.1%) and 28 of educated patients (62.2%) believed that vegetables, fruits and sugarcane had a beneficial effect on the liver. Main source of dietary information to the patients was the doctor. On sub-group analysis those who restricted diet irrespective of their educational level, had more patients with BMI less than 18.5 kg/m2, (CI 0.01-0.94, p-0.001), haemoglobin less than 12 g/dl (CI 0- 0.03, p-0.001) and serum albumin less than 3 g/dl (CI 0.1- 03, p-0.001). Conclusion: Both educated and uneducated classes of the patients have improper knowledge and perception of diet in cirrhosis. Patients with cirrhosis who restricted diet, had relatively low BMI, haemoglobin and albumin as compared to those who did not restrict. Main source of dietary information to cirrhotic patients were health care personnels

Item analysis for measuring student and academic advisor's perspective towards the function of academic advising in Malaysian public universities

In Malaysian public universities, academicians are appointed as academic advisors. This action often leads to misunderstandings on the function of academic advising among students and academic advisors. Previous studies examining this misunderstanding were conducted using standardized instrument. These instruments were developed by researchers from advanced countries where professionals are employed as academic advisors. These standardized instruments lack of local context, differentiatition between academicians and professionals, and statistical properties including individual item quality and ability. This study fills this gap by identifying the rank of each item of the self-developedquestionnaire regarding the function of academic advising from the perspective of student and academic advisor. The questionnaire in this study was developed based on the findings of the preliminary qualitative study. The questionnaire consists of three constructs: academic, social, and personal. A total of 400 students and 80 academic advisors from two public universities ranked each item of the questionnaire based on four-point scales. The questionnaire was analysed using Rasch measurement model. The findings showed that students perceive academic aspect while academic advisors perceive personal development aspect as the most important function of academic advising. Students and academic advisors perceived social aspect as the least important of academic advising. Finally, students perceived personal development aspect while academic advisors considered academic aspect as the second important function of academic advising. The findings could serve as a guideline to improve the quality of academic advising programme in Malaysian public universities

Remote Sensing of the Glacial Environment Influenced by Climate Change

Remote sensing-based observations prove to be critical for the monitoring and assessment of cryosphere in the Himalayan region, where routine data collection in mountainous regions is often hampered by highly inaccessible terrain and harsh climatic conditions. The glacierized region of High Asia is also facing the effects of climate change in the form of rapid melting of glacial ice, creation of new lakes, and expansion of the existing ones, which eventually result in hazardous glacial floods downstream. Multisensor remote sensing (RS) data, e.g., MODIS, Landsat-7 & 8, and SPOT-5 XS, coupled with Google Earth and digital elevation model (DEM) data were used to investigate the snow/glacier resources and their dynamics in the Karakoram–Himalaya basins adopting variable image interpretation and modeling techniques. Minimum numbers of large-sized glaciers were identified in the Himalaya range, which points toward higher rates of glacial ice melting in this range. On the contrary, the presence of relatively higher numbers of medium- to large-sized glaciers in the Karakoram range provides an evidence of favorable climate conditions for the glaciers\u27 existence at higher altitudes. A significant gain in snow cover was observed in Hunza basin during the 2001–2011 period, which may feed high-altitude zone resulting in net expansion of the snow cover and ice mass gain in the Karakoram. The integrated use of RS and geographical information systems (GIS) techniques with sparse in situ data is found to be helpful in analyzing the glacial environment in the context of changing climate in the high-altitude Himalayan region

Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians

AIM: To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.Methods: Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs) during the period 1999 to 2004 were analyzed. Patient\u27s characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved (intestinal, peritoneal, visceral, and nodal) and response to treatment was also noted.Results: There were 209 patients enrolled. One hundred and twenty-three (59%) were females. Symptoms were abdominal pain 194 (93%), fever 134 (64%), night sweats 99 (48%), weight loss 98 (47%), vomiting 75 (36%), ascites 74 (35%), constipation 64 (31%), and diarrhea 25 (12%). Sub-acute and acute intestinal obstruction was seen in 28 (13%) and 12 (11%) respectively. Radiological evidence of pulmonary tuberculosis was found in 134 (64%) patients. Basis of diagnosis of abdominal tuberculosis were radiology (Chest and barium X-Rays, Ultrasound and CT scan abdomen) in 111 (53%) and histo-pathology (tissue obtained during surgery, colonoscopy, CT or ultrasound guided biopsy, laparoscopy and upper gastro intestinal endoscopy) in 87 (42%) patients. Mycobacterium culture was positive in 6/87 (7%) patients and response to therapeutic trial of anti tubercular drugs was the basis of diagnosis in 5 (2.3%) patients. Predominant site of involvement by abdominal TB was intestinal in 103 (49%) patients, peritoneal in 87 (42%) patients, solid viscera in 10 (5%) and nodal in 9 (4%) patients. Response to medical treatment was found in 158 (76%) patients and additionally 35 (17%) patients also underwent surgery. In a 425 +/- 120 d follow-up period 12 patients died (eight post operative) and no case of relapse was noted.CONCLUSION: Abdominal TB has diverse and non- specific symptomatology. No single test is adequate for diagnosis of abdominal tuberculosis in all patients. Abdominal TB in non-HIV patients remains an ongoing diagnostic dilemma requiring a high index of clinical suspicion

OUTCOME OF ENDOSCOPIC THERAPEUTIC INTERVENTIONS: ARE THEY DIFFERENT AMONG VARIOUS NON- MALIGNANT ESOPHAGEAL DISEASES

Background: This study was carried out to evaluate and compare the outcome of various causes of non-malignant lesions of the esophagus after endoscopic therapeutic intervention. Methods: A cohort of patients with non-malignant dysphagia presenting at Aga Khan University hospital, a tertiary care setting who underwent endoscopic intervention was studied. Response to treatment was evaluated by improvement in dysphagia score on a scale of 0-4 and weight gain. Results:99 subjects (53 males) were included. Mean age was 48.6 +/- 17.2 years. Dysphagia for solids was present in 48%, for liquids in 3% and for both in 49% patients. Significant weight loss (\u3e10% body weight) occurred in 35 (35.3%) patients. Achalasia was diagnosed in 49.5%, peptic stricture in 30.4%, post sclerotherapy stricture in 12.1%, corrosive injury in 4%, post-operative stricture in 4%. In comparative analysis of achalasia and inflammatory groups, good response to dysphagia was seen in 40/49 (82%) and 22/50 (44%) respectively p \u3c 0.001. Weight gain was 35/49 (72%) and 22/50 (44%) p Conclusion: Dysphagia and weight loss were common presentations in non-malignant esophageal diseases. Therapeutic intervention in inflammatory group was associated with high complication than the achalasia group

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy