Clinical practice guidelines on the management of variceal bleeding

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 infections, hepatic encephalopathy, coagulopathy and thrombocytopenia, and specific therapy. Rebleeding occurs in about 60% patients within 2 years of their recovery from first variceal bleeding episode, with 33% mortality. Therefore, it is mandatory that all such patients must be started on combination of β-blockers and band ligation to prevent recurrence of bleeding. Patients who required shunt surgery/TIPSS to control the acute episode do not require further preventive measures. These clinical practice guidelines (CPGs) have been jointly developed by Pakistan Society of Hepatology (PSH) and Pakistan Society of Study of Liver Diseases (PSSLD)

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.Peer reviewe

12 hours post admission troponin T levels are consistent with the infarct size in patients with ST segment elevation myocardial infarction.

Background: Current guidelines recommend the use of Troponin T as biomarker of choice for the diagnosis of AMI. Data revealing relationship between TNT and infarct size in patients with STEMI are limited. Objective: To evaluate the relationship between cardiac TnT levels with infarct size measured by ECG and Echo in patients with STEMI. Methods: It is a prospective analysis of 116 consecutive patients with STEMI who were brought to the CCU. Their ECGs were recorded at the time of admission and Troponin T levels were measured at 12 hours of their presentation to the hospital. Their Echo was done 48 hours post admission. The relationship between infarct size and TnT levels was studied. Results: A total of 116 consecutive patients (age, 58 ± 17 years; 18% women) with STEMI were studied. The areas of infarction determined by ECG Vs Echo were IWMI in 37% Vs 36%, ASMI in 19% Vs 20%, ALMI in 18% & Extensive anterior in 13% Vs ALMI 36%, PWMI in 4% Vs IPMI in 5% respectively and 2% were global in location on ECG. Regarding levels of TnT, 48% had high positive i,e \u3e2.0ng/ml, 52% had quantitative readings (20% had 1.51-2.0ng/ml, 18% had 1.0-1.50ng/ml and 14% had 0.51-1.0ng/ml). None of them had low positive value i,e \u3c0.1ng/ml. The mean value of Troponin T in PWMI is 1.11ng/ml, IWMI is 1.23ng/ml, LWMI is 1.33ng/ml, ASMI is 1.62ng/ml and for ALMI, Extensive MI and global MI is \u3e2.0ng/ml Conclusion: TnT is a reliable and cost effective tool at 12 hours post STEMI to aid in quantification of infarct size measured by ECG and Echo. It can also gives us a clue of bedside evaluation of post MI LV function which can later be revealed by much expensive cardiac MRI and SPECT Myocardial perfusion imaging scans. Keywords: ASMI- Anteroseptal Myocardial Infarction, ALMI- Anterolateral Myocardial Infarction, IWMI-Inferior Myocardial Infarction, IPMI- Infero-posterior M

Hypertension in alone and in combination with other stroke risk factors is associated with increased incidence of in-hospital mortality

Objective: To determine the outcome of hypertension alone and in combination with additional risk factors in a hospitalized stroke patient. Material & Methods: A retrospective analysis of 87 stroke patients who presented to Medical Unit-I of Lahore General Hospital, Lahore from January- March 2013. These patients were enrolled and the data was analyzed on SPSS version19 on which relevant details were noted and descriptive statistics like frequency mean and percentages were calculated. Overall frequency of isolated or multiple risk factors like Hypertension, Diabetes Mellitus, Smoking, Previous Stroke, and Ischemic Heart Disease, Valvular Heart Disease contributing to mortality was determined by age, gender and CT scan findings. Results: Out of 87 patients, 65.5%(n=57) were discharged healthy and 34.5%(n=30) died during their hospital stay. The mean age of the group died was 62.4 years with a range of 28-90 years having 50%(n=15) males and 50%(n=15) females. Out of 30 deaths 40% (n=12) were having multiple co-morbidities like HTN, DM and IHD, 20%(n=6) were having HTN, DM and Smoking, 16.7%(n=5) with HTN and DM, 16.7%(n=5) with HTN and smoking and only 6.7%(n=2) with HTN. Of these patients, Intracerebral Hemorrhage 56.7%(n=17) and Cerebral Infarct 43.3%(n=13) were the CT scan findings. The patients reaching the hospital for more than 24 hours of symptoms onset were 62% (n=19), between 18-24 hours were 18%(n=5), between 12-18 hours were 10%(n=3), between 3-12 hours were 7%(n=2) and less than 3 hours were 3%(n=1) Conclusion: Majority of old aged patients with multiple risk factors and arriving late to the tertiary care centre had high risk of In-Hospital mortality with Hypertension in alone as well as with other co-morbidities is the leading risk factor in stroke related deaths. Keywords: HTN- Hypertension, IHD- Ischemic Heart Disease, DM- Diabetes Melitus, ICH- Intracerebral Hemorrhag

POINT PREVALENCE OF COLORECTAL CANCER IN A MEGA CITY OF PAKISTAN, KARACHI – A CROSS SECTIONAL STUDY

Background and Objective: Globally, Colorectal Cancers are also third most common cancers and fourth leading cause of death due to carcinoma. Burden of Colorectal Cancers is also high in Pakistan. The main risk factor for Colorectal Cancer is age, however, other risk factors are e.g. family history, irritable bowel disease, sedentary life-style, high visceral adipose tissues, smoking and alcohol. Hence; the main objective of current study was to determine point prevalence of Colorectal Cancers in a mega city of Pakistan, Karachi; a representative population of Pakistan. It is hypothesized that incidences of Colorectal Cancers would be higher in Karachi than rest of the country.   Materials and Methods: The retrospective cross-sectional study was conducted in Karachi. Duration of study was from January-2015 to October-2019. Data has been collected from two state-owned and four private hospitals of Karachi. Precision analysis technique was used to determine the sample size of study. Study is approved by Board of Advanced Studies & Research, University of Karachi (Reference Number: BASR/01046/Pharm.). Objective of study was explained to patients before initiation the study; informed consent was taken from each patient. S.P.S.S (Statistical-Package-for-Social-Sciences) software version 22 was used to analyze the data. Results: Among 1,617 patients: male 54.35% (N=879); female 45.64% (N=738). Mean age of diagnosis of colorectal cancer: male 49.51±14.72 years; female 45.28±13.52 years. Significantly higher point prevalence was found in ethnicity speaking Sindhi compared with ethnicity speaking Balochi (p=0.001), Pashto (p=0.0001), Punjabi (p=0.001) and Siraiki (p=0.0001); Urdu speaking compared with Balochi speaking (p=0.0001), Pashto speaking (p=0.0001), Punjabi speaking (p=0.0001) and Siraiki speaking (p=0.0001) in male. In female; Sindhi speaking point prevalence is significantly higher than Siraiki speaking (p=0.028); Urdu speaking point prevalence is significantly higher than patients speaking Balochi (p=0.012), Pashto (p=0.002), Punjabi (p=0.002) and Siraiki (p=0.0001).  Conclusion: Allocation of resources are required at governmental and non-governmental level for early screening. National cancer registry program should also be initiated to support health policy makers for the development of counter strategies.                          Peer Review History: Received: 26 February 2023; Revised: 13 March; Accepted: 27 April 2023, Available online: 15 May 2023 Academic Editor: Prof. Cyprian Ogbonna ONYEJI, Obafemi Awolowo University, Ile-Ife, Nigeria, [email protected] Received file:                             Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, [email protected] Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, [email protected]

Dengue virus serotype 2 (DEN-2): the causative agent of 2011-Dengue epidemic in Pakistan

Abstract Introduction: Dengue virus (DENV) is an arthropod-borne virus that belonged to the Flaviviridae viral family. Four known serotypes DEN-1 through DEN-4 do exist and circulate in diverse geographical regions of the world causing epidemics. The management of dengue patients, and especially dengue hemorrhagic fever (DHF)/Dengue shock syndrome (DSS) cases, has been a challenge in Pakistan now days. Method: We have carried out a comprehensive study of the current outbreaks of dengue virus infection on molecular level with the aim to find out the common serotype/s of DENV responsible for this outbreak using PCR, real-time PCR and nucleotide sequencing targeting the C-prM gene junction. For this purpose total 1129 serum samples received between from start of August till end of November 2011 from all the major hospitals of Lahore, Punjab at Division of Molecular Virology, National Centre of Excellence in Molecular Biology (CEMB) University of the Punjab Lahore were utilized for the DENV diagnosis and serotypes/genotypes analysis. Results: Male female ratio of the suspected dengue patients was 2.4:1. Their mean age were 31.14 + 16.03 (SD) years ranging from 9 months to 90 years. Out of these 1129 serum samples, total 930 (82.37%) were found infected with DENV. Out of the 930 DENV RNA positive samples, 893 (96.02%) had DEN-2 Am. J. Biomed. Sci. 2012, 4(4), 307-315; doi: 10.5099/aj120400307 © 2012 by NWPII. All rights reserved. 308 and 37 (3.97%) sample had concurrent infection with serotypes 2 and 3. Conclusion: Based on the results of this study we conclude that DEN-2 is the responsible genotype for the current dengue epidemic that started from the beginning of year 2011 and is continuing till now. The additional serotype detected in the current study was serotype 3 that remained in very low frequency in Pakistan for last several decades