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Rising incidence of acute hepatitis A among adults and clinical characteristics in a tertiary care center of Pakistan

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World Journal of Virology 2025年第1期14卷 73-82页

作者： Yumna Shahid Amna Subhan Butt Iqra Jamali Faisal Wasim Ismail Division of Gastroenterology Department of MedicineAga Khan University HospitalKarachi 74800Pakistan Department of Medicine Aga Khan University HospitalKarachi 74800Pakistan

BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among ***,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among *** To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)*** This was a trend analysis conducted at aga khan university hospital Karachi(Sindh,Pakistan)from February 2024 to May *** aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were *** compare the trend patients admitted with acute hepatitis during 2019-2023 were also *** regarding clinical and laboratory parameters were *** yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among *** A total of 396 patients were found to have acute hepatitis during our study *** was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV ***,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute *** trends showed increasing occurrence of HAV infection among adults over last 5 *** patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV ***,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in *** An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.

关键词： Acute hepatitis Hepatitis A virus Hepatitis E virus Acute liver failure Hepatotropic virus Vaccination

Spectrum of venous thromboembolism in adult patients with ulcerative colitis in Pakistan:A single center retrospective study

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World Journal of Clinical Cases 2025年第6期13卷 9-13页

作者： Masood Muhammad Karim Hafsa Shaikh Faisal Wasim Ismail Department of Medicine The Aga Khan University HospitalKarachi 74800Pakistan Department of General Surgery The Aga Khan University HospitalKarachi 74800Pakistan

BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general *** the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic *** To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop *** This was a retrospective chart review done in The Gastroenterology Department of The aga khan university *** was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December *** Seventy-four patients fulfilled the inclusion *** mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 *** and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed *** venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)*** the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international ***,multi-centric studies are required to further explore these results.

关键词： Deep venous thrombosis Inflammatory bowel disease Low-middle-income country Anticoagulation Protein C deficiency

Effect of cytokine gene polymorphism on histological activity index, viral load and response to treatment in patients with chronic hepatitis C genotype 3

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World Journal of Gastroenterology 2005年第42期11卷 6656-6661页

作者： Zaigham Abbas Tariq Moatter Akber Hussainy Wasim Jafri Department of Medicine The aga khan university hospital Karachi Pakistan Department of Pathology The aga khan university hospital Karachi Pakistan

AIM： To investigate the association between cytokine gene polymorphism and disease status in chronic hepatitis C genotype 3 by liver biopsy, ALl, HCV RNA levels and response to treatment. METHODS： Patients with chronic hepatitis C genotype 3 were analyzed for single nucleotide polymorphisms of interleukin （IL）-10, IL-1 beta, interferon-gamma （IFN-y）, tumor necrosis factor-alpha （TNF-y） and transforming growth factor-beta （TGF-β） by polymerase chain reaction using sequence-specific oligonucleotide primers. Liver biopsies were assessed by modified histological activity index （HAI） scoring system using a scale of 0-18 for grading the necro-inflammatory activity and 0-6 for staging the fibrosis. HCV RNA levels were determined by bDNA assay. The patients were treated with interferon alpha and ribavirin for 6 mo. Sustained virological response was assessed 6 mo after the completion of the treatment. RESULTS： Out of the 40 patients analyzed, 26 were males. Mean age was 40.5±12.5 years （range 18- 65 years）. The frequencies of different dimorphic polymorphisms based on single nucleotide substitution were as follows： IL-10-1082 G/A 85%, A/A 12.5%, G/ G 2.5%; IL-10-819 A/C 87.5%, C/C 10%, A/A 2.5%; IL-10-592 C/A 72.5%, C/C 27.5%; IL-1 C 90%, U 10%; IFN-874 T/A 50%, T/T 27.5%, A/A 22.5%; TNF-308 A/G 95%, G/G 5%; TGF-10 T/C 52.5%, C/C 35%, T/T 12.5%. The mean grades of necroinflammatory activity of different genotypes of IL-10 at promoter site -1082 were A/A = 3.6, A/G = 5.0, and G/G = 10.0 and the difference was significant （P = 0.029）. The difference in the stage of disease at a scale of 0-6 was A/A 0.8, A/G 2.3, and G/G 4.0 （P = 0.079）. The difference in the HAI seemed to be related to the presence of allele -*** IL-10 -819 genotypes, mean scores of fibrosis were A/A = 6.0, A/C = 2.2, and C/C = 1.0 （P = 0.020） though the inflammatory activity was not much different. No significant differences in HAI were noted among polymorphisms of other cytokines. Moreover, ALT and HC

关键词： Interleukin Interferon gamma Tumornecrosis factor alpha Transforming growth factor Cytokines Gene polymorphism Hepatitis C Alanineaminotransferase Liver biopsy

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

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World Journal of Gastroenterology 2006年第39期12卷 6371-6375页

作者： Rustam khan Shahab Abid Wasim Jafri Zaigham Abbas Khalid Hameed Zubair Ahmad Section of Gastroenterology Department of Medicine The Aga Khan University Hospital Karachi Pakistan Department of Surgery The Aga Khan University Hospital Karachi Pakistan Department of pathology The Aga Khan University Hospital Karachi Pakistan

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＇s 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 294 （93%）, fever 234 （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 nonspecific symptomatology. No single test is adequate for d

关键词： Abdominal tuberculosis Gastrointestinal tuberculosis Tuberculosis Diagnosis and abdominal tuberculosis

Clinical presentation and genotype of hepatitis delta in Karachi

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World Journal of Gastroenterology 2007年第18期13卷 2604-2607页

作者： Tariq Moatter Zaigham Abbas Sabhita Shabir Wasim Jafri Departments of Pathology The Aga Khan University Hospital Karachi 74800 Pakistan The aga khan university hospital Karachi and Medicare Clinic Karachi 74800 Pakistan Departments of Medicine The Aga Khan University Hospital Karachi 74800 Pakistan

AIM： To assess the clinical presentation and genotypes of delta hepatitis in local population. METHODS： In this prospective study, 39 consecutive patients who were positive for HBsAg and hepatitis D virus （HDV） antibody were included. The patients were divided in two groups on the basis of presence or absence of HDV RNA and a comparative study was done. Genotype of HDV was determined in PCR positive patients. RESULTS： Overall there is male dominance, in which 34 patients out of 39 （87.2%） were male. Twenty （51%） patients were from the adjacent areas of three provinces; Sindh, Punjab and Balochistan indicating the higher prevalence of delta hepatitis in this mid region of Pakistan. Patients of all age groups were affected with delta hepatitis （median 31.5 years, range 12-75）. HDV RNA was detectable in 23 patients （59%）. All the HDV strains belonged to genotype I. HBV DNA was detectable only in 3 cases who were also HBeAg and HDV RNA positive. Patients with detectable HDV RNA were younger than patients with undetectable RNA; mean age 29.7±12.8 years vs 36.8±15.2. There were no statistically significant differences in the clinical presentation and routine biochemical profile of patients with detectable or undetectable HDV RNA. Clinical cirrhosis was present in 19 （49%） patients; 12 with detectable RNA and 7 with undetectable HDV RNA （P = 0.748）. Decompensated disease was seen in eight patients; five and three respectively from each group. Four patients with undetectable RNA and two patients with detectable RNA had normal ALT and ultrasound abdomen. CONCLUSION： HDV may infect at any age, usually young adult males. Genotype I is prevalent. With time some of the patients become HDV RNA negative or asymptomatic carrier. Most of the patients have suppressed HBV DNA replication. Significant numbers of patients have cirrhosis.

关键词： Hepatitis delta Hepatitis B Genotype HBeAg Pakistan

Gastric juice for the diagnosis of H pylori infection in patients on proton pump inhibitors

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World Journal of Gastroenterology 2008年第10期14卷 1539-1543页

作者： Javed Yakoob Shahid Rasool Zaigham Abbas Wasim Jafri Shahab Abid Muhammad Islam Zubair Ahmad Department of Medicine Aga Khan University Hospital Karachi 74800 Pakistan Department of Pathology Aga Khan University Hospital Karachi 74800 Pakistan

AIM: To determine the efficacy of gastric juice polymerase chain reaction (PCR) for the detection of H pylori infection in comparison with histology and gastric antral biopsy PCR in patients on a proton pump inhibitor (PPI). METHODS: Eighty-five consecutive patients with dyspeptic symptoms were enrolled. Gastric biopsies for histology, PCR and gastric juice were collected at endoscopy for PCR of the H pylori urease C gene (ure C). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive and negative likelihood ratio for PCR of gastric juice for the H pylori ure C gene was compared to histology and gastric antral biopsy H pylori ure C PCR in patients with and without PPI. RESULTS: Gastric juice PCR was positive in 66 (78%) patients. Histology showed H pylori associated gastritis in 57 (67%). Gastric biopsy PCR was positive in 72 (85%). In patients not taking PPI, the sensitivity, specificity, PPV, NPV, accuracy and positive and negative likelihood ratio for gastric juice PCR were 89%, 72%, 91%, 67%, 90%, 85%, 3.1 and 0.1 respectively. In patients on PPI these values were 86%, 100%%, 100%, 29%, 86%, 9.5 and 1.4, respectively. CONCLUSION: Gastric juice PCR for the diagnosis of H pylori infection has increased sensitivity compared to histology with PPI. The use of gastric juice PCR is recommended to confirm H pylori status in patients taking PPIs.

关键词： H pylori Proton pump inhibitor Gastric juice Polymerase chain reaction Histology

Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low-to middle-income country

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World Journal of Emergency Medicine 2017年第3期8卷 184-189页

作者： Muhammad Akbar Baig Hira Shahzad Erfan Hussain Asad Mian Department of Emergency Medicine Aga Khan University Hospital Department of Medicine Aga Khan University Hospital Adult Critical Care Services Aga Khan University Hospital Department of Emergency Medicine Pediatrics and Child Health Aga Khan University Hospital

BACKGROUND: Timely identifi cation of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care(POC) testing is being increasingly utilized in the emergency department(ED). We examined the accuracy and timesaving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED ***: A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fi ngertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation(ICC) and Bland and Altman ***: Forty-three septic patients were included in the study. The fingertip POC & whole blood POC lactate measurements each correlated tightly with the reference method(ICC=0.93 & ICC=0.92, respectively). Similarly at 6 hours, the fingertip POC & whole blood POC lactate measurements demonstrated satisfactory correlation with the reference method(ICC=0.95 & ICC=0.97, respectively).CONCLUSION: Fingertip POC lactate measurement is an accurate method to determine lactate levels in septic ED *** WORDS: Sepsis; Point of care; Lactate; Emergency department;

关键词： Sepsis Point of care Lactate Emergency department Pakistan

Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

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World Journal of Gastroenterology 2007年第8期13卷 1247-1251页

作者： Khalid Mumtaz Shahid Majid Hasnain A Shah Kashif Hameed Ashfaq Ahmed Saeed Hamid Wasim Jafri Section of Gastroenterology Aga Khan University HospitalKarachiPakistan

AIM： To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate （NBC） sclerotherapy of gastric varix （GV）. METHODS： We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal （GI） bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis （bleeding control within the first 48 h）, recurrent bleeding （after 48 h of esophagogastro-duodenoscopy） and in-hospital mortality were analyzed. RESULTS： The prevalence of GV in patients with portal hypertension was 15% （220/1436） and the incidence of bleeding was 22.7% （50/220）. Out of the 50 bleeding GV patients, isolated gastric varices （IGV-Ⅰ） were seen in 22 （44%）, gastro-oesophageal varices （GOV） on lesser curvature （GOV-Ⅰ） in 16 （32%）, and GOV on greater curvature （GOV-Ⅱ） in 15 （30%）. IGV-Ⅰ was seen in 44% （22/50） patients who had bleeding as compared to 23% （39/170） who did not have bleeding （P 〈 0.003）. Primary hernostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 （14%） patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7 （57%）. Three patients died after repeat sclerotherapy, one during transjugular intrahepatic portosystemic stem shunt （TIPSS）, one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% （3/50）. CONCLUSION： GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding. In hospital mortality of patients with bleeding GV is 6%.

关键词： Gastric varices Portal hypertension N-butyl cyanoacrylate Bleeding Sclerotherapy

Atypical focal nodular hyperplasia of the liver

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Hepatobiliary & Pancreatic Diseases International 2011年第1期10卷 104-106页

作者： Muhammad Rizwan khan Taimur Saleem Tanveer Ul Haq Kanwal Aftab Section of General Surgery Department of Surgery Aga Khan UniversityStadium Road Department of Pathology Aga Khan UniversityStadium Road Section of Interventional Radiology Department of RadiologyAga Khan UniversityStadium Road aga khan university hospital Medical College Aga Khan UniversityStadium Road

BACKGROUND:Focal nodular hyperplasia,a benign hepatic tumor,is usually ***,rarely the entity can cause symptoms,mandating intervention. METHOD:We present a case of focal nodular hyperplasia of the liver,which caused a considerable diagnostic dilemma due to its atypical presentation. RESULTS:A 29-year-old woman presented with a 15-year history of a progressively increasing mass in the right upper quadrant which was associated with pain and emesis. Examination showed a firm,mobile mass palpable below the right subcostal margin.A computed tomography scan of the abdomen showed an exophytic mass arising from hepatic segments III and *** biopsy of the hepatic mass was *** showed a vascular tumor that was supplied by a tortuous branch of the proper hepatic artery. Surgical intervention for removal of the mass was undertaken. Intra-operatively,two large discrete tumors were found and completely *** examination showed features consistent with focal nodular hyperplasia. CONCLUSION:This description of an unusual case of focal nodular hyperplasia of the liver highlights the point that the diagnosis of otherwise benign hepatic tumors may be difficult despite extensive work-up in some cases.

关键词： focal nodular hyperplasia atypical liver