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Impact of sepsis and non-communicable diseases on prognostic models to predict the outcome of hospitalized chronic liver disease patients

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World Journal of Hepatology 2018年第12期10卷 944-955页

作者： Fakhar Ali Qazi Arisar Shahab Abid Preet Ayoub Shaikh safia awan Section of Gastroenterology Department of MedicineFaculty Offices Buildingthe Aga Khan University Hospital

AIM To evaluate the impact of sepsis and non-communicable diseases(NCDs) on the outcome of decompensated chronic liver disease(CLD) *** this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were *** older than 18 years with decompensation of CLD(i.e., jaundice, ascites,encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital stay(> 5 d), and early readmission(within 7 d).RESULTS A total of 399 patients were enrolled. The mean age was 54.3 ± 11.7 years and64.6%(n = 258) were male. Six-week mortality was 13%(n = 52). Prolonged hospital stay and readmission were present in 18%(n = 72) and 7%(n = 28) of patients, respectively. NCDs were found in 47.4%(n = 189) of patients. Acute kidney injury, sepsis, and non-ST elevation myocardial infarction were found in41%(n = 165), 17.5%(n = 70), and 1.75%(n = 7) of patients, respectively. Upon multivariate analysis, acute kidney injury, non-ST elevation myocardial infarction, sepsis, and coagulopathy were found to be statistically significant predictors of mortality. While chronic kidney disease(CKD), low albumin, and high Model for End-Stage Liver Disease(MELD)-Na score were found to be statistically significant predictors of morbidity. Addition of sepsis in conventionalMELD score predicted mortality even better than MELD-Na(area under receiver operating characteristic: 0.735 vs 0.686; P < 0.001). Among NCDs, CKD was found to increase morbidity *** Addition of sepsis improved the predictability of MELD score as a prognostic marker for mortality in patients with CLD. Presence of CKD increases the morbidity of patients with CLD.

关键词： Chronic liver disease Mortality Morbidity Prognostic factors Noncommunicable diseases Sepsis

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Helicobacter pylori outer membrane protein Q genotypes and their susceptibility to antiadhesive phytotherapeutic agents

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Journal of Integrative Medicine 2017年第5期15卷 398-406页

作者： Javed Yakoob Zaigham Abbas Malik Hassan Mehmood Kanwal Tariq Saima Azhar Saleem safia awan Abdul Malik Saeed Hamid Rustam Khan Wasim Jafri Department of Medicine Aga Khan UniversityKarachi 74800Pakistan Department of Biological Biomedical Sciences Aga Khan UniversityKarachi 74800Pakistan

OBJECTIVE： Helicobacter pylori is a Gram-negative organism. Its outer membrane protein Q（Hop Q） mediates host-pathogen interactions; Hop Q genotypes 1 and 2 are found associating with gastroduodenal pathologies. The authors measured the anti-adhesion effects of the extracts of Abelmoschus esculentus, Zingiber officinale, Trachyspermum ammi, Glycyrrhiza glabra, Curcuma longa and Capsicum annum against Hop Q genotypes and H. pylori cytotoxin-associated gene A（Cag A）.METHODS： DNA was extracted by polymerase chain reaction of the Hop Q genotypes（i.e., type 1, type 2 and Cag A） from 115 H. pylori strains. The effect of the extracts from selected dietary ingredients was determined using a gastric adenocarcinoma cell line and a quantitative DNA fragmentation assay. The anti-adhesive effect of these extracts on H. pylori was tested using an anti-adhesion ***： C. annum, C. longa and A. esculentus showed prominent anti-adhesion effects with resultant values of 17.3% ± 2.9%, 14.6% ± 3.7%, 13.8% ± 3.6%, respectively, against Hop Q type 1 and 13.1% ± 1.7%, 12.1% ± 2%, 11.1% ± 1.6%, respectively, against Hop Q type 2. C. longa（93%）, C. annum（89%） and A. esculentus（75%） had better anti-adhesive activity against H. pylori with Hop Q type 1 compared to Hop Q type 2 with respective values of 70%, 64% and 51%. Extracts of C. annum（14.7% ± 4.1%）, A. esculentus（12.3% ± 4.1%） and Z. officinale（8.4% ± 2.8%） had an anti-adhesion effect against Cag A-positive H. pylori strains compared to Cag A-negative strains.

关键词： outer membrane protein Q Helicobacter pylori anti-adhesion Abelmoschus esculentus Capsicum annum Curcuma Ionga

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HCV-discovery to elimination, 'myth or reality'

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Hepatoma Research 2018年第9期4卷 37-44页

作者： Wasim Jafri Basit Siddiqui safia awan Aga Khan University Department of Medicine Section of GastroenterologyKarachi 75500Pakistan

Hepatitis C virus (HCV) was discovered in 1989, before that it was commonly known as transfusion associated non A non B hepatitis. It rapidly assumed the role of leading cause of cirrhosis and liver cancer and a leading indication for liver transplant globally. For over two decades the treatment was suboptimal with the use of pegylated interferon and ribavirin combination across all genotypes. The vaccine development also failed for over two decades. However a major breakthrough happened in December 2013 when the Food and Drug Administration (FDA) approved the first pan genotypic oral directly acting drug Sofosbuvir. Since then many new directly acing drugs have been approved through fast track by the FDA. Today we have directly acting antiviral agents for all HCV patients providing cure rates of over 90%. Looking into this success the World Health Organization has set targets for 2030 for HCV elimination. There are several countries which have formed strategies to achieve this goal and others are still thinking to develop their own strategies. The availability of generics have reduced the prices substantially, however the problem is so gigantic that unless proper operational strategies for elimination are developed by the developing world especially by China and Pakistan, the two counties having the largest existing pool of HCV patients, the goals of elimination may not come true.

关键词： Hepatitis C virus elimination directly acting antiviral agents Pakistan

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Itopride for gastric volume,gastric emptying and drinking capacity in functional dyspepsia

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第1期8卷 74-80页

作者： Shahab Abid Wasim Jafri Maseeh Uz Zaman Rakhshanda Bilal safia awan Aamir Abbas Department of Medicine Aga Khan University Department of Radiology Aga Khan University Pakistan Atomic Energy Commission

AIMTo study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia (FD). METHODSRandomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacity of 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 was checked using satiety drinking capacity test. The intervention group comprised of 150 mg itopride. Patients in both arms were followed for 4 wk. RESULTSMean age of the recruited participant 33 years (SD = 7.6) and most of the recruited individuals, i.e., 21 (67.7%) were males. We found that there was no effect of itopride on gastric accommodation as measured at different in volumes in the itopride and control group with the empty stomach (P = 0.14), at 20 min (P = 0.38), 30 min (P = 0.30), 40 min (P = 0.43), 50 min (P = 0.50), 60 min (P = 0.81), 90 min (P = 0.25) and 120 min (P = 0.67). Gastric emptying done on a sub sample (n = 11) showed no significant difference (P = 0.58) between itopride and placebo group. There was no significant improvement in the capacity to tolerate liquid in the itopride group as compared to placebo (P = 0.51). Similarly there was no significant improvement of symptoms as assessed through a composite symptom score (P = 0.74). The change in QT interval in itopride group was not significantly different from placebo (0.10). CONCLUSIONOur study found no effect of itopride on gastric accommodation, gastric emptying and maximum tolerated volume in patients with FD.

关键词： Itopride Gastric emptying Gastric accommodation Functional dyspepsia Dyspepsia

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