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Des-gamma-carboxy prothrombin and alpha-fetoprotein levels as biomarkers for hepatocellular carcinoma and their correlation with radiological characteristics

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World Journal of Gastrointestinal Pathophysiology 2024年第1期15卷 37-43页

作者： Muhammad Ali Qadeer Zaigham Abbas Shaima Amjad Bushra Shahid Abeer Altaf Mehreen Siyal Department of Hepatogastroenterology Dr.Ziauddin University Hospital CliftonKarachi 75600Pakistan Medicine Dr.Ziauddin University Hospital CliftonKarachi 75600Pakistan Internal Medicine Dr.Ziauddin University Hospital CliftonKarachi 75600Pakistan

BACKGROUND Alpha-fetoprotein(AFP),a commonly used biomarker for hepatocellular carcinoma(HCC),is normal in up to one-third of *** To evaluate the diagnostic performance of des-gamma-carboxy-prothrombin(DCP)alone and in combination with *** In this study,202 patients with radiologically proven HCC were enrolled,and their DCP and AFP levels were evaluated for their diagnostic *** The mean age of the enrolled patients was 58.5 years;72.0%were *** was elevated in 86.6%(n=175)of all patients,100.0%(n=74)of patients with portal vein thrombus,and 87.4%(n=111)of patients with multicentric *** was elevated in 64.3%(n=130)of all the patients,74%(n=55)of the patients with portal vein thrombus,and 71.6%(n=91)of the patients with multicentric HCC(P=0.030,0.001,and 0.015,respectively).In tumors less than 2 cm in size(n=46),DCP was increased in 32(69.5%)patients,and AFP was increased in 25(54.3%)patients(P=0.801).There was good pairing between DCP and AFP for HCCs of 2 cm size or larger(P2 cm was 0.74 for DCP and 0.59 for AFP;combining both markers resulted in an AUROC of *** tumors<2 cm,the AUROC was 0.25 for DCP and 0.40 for *** DCP,as an individual marker,had a better diagnostic performance in many cases of ***,DCP may replace AFP as the primary HCC biomarker.

关键词： Des-gamma-carboxy prothrombin Protein induced by vitamin K absence-II Cirrhosis Alpha-fetoprotein Biomarkers Hepatocellular carcinoma Portal vein thrombus

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Is there a need for universal double reflex testing of HBsAg-positive individuals for hepatitis D infection?

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World Journal of Hepatology 2024年第3期16卷 300-303页

作者： Zaigham Abbas Minaam Abbas Department of Hepatogastroenterology and Liver Transplantation Dr.Ziauddin University HospitalKarachi 75600SindhPakistan Department of Medicine University of CambridgeCambridge CB20SPUnited Kingdom

Hepatitis D virus(HDV)can infect HBsAg-positive individuals,causing rapid fibrosis progression,early decompensation,increased hepatocellular carcinoma risk,and higher mortality than hepatitis B virus(HBV)*** countries lack high-quality HDV prevalence data,and the collection techniques employed often bias published *** recent meta-analyses,HDV prevalence in HBsAg-positive patients reaches 5%-15%and is even significantly higher in endemic *** HBV vaccination programs were implemented,HDV prevalence has decreased among younger ***,owing to immigrant influx,it has increased in some Western *** current practice of HDV screening in HBsAg-positive individuals is stepwise,based on physician’s discretion,and limited to at-risk populations and may require numerous *** reflex testing,which includes anti-HDV testing in all HBsAg-positive individuals and then HDV RNA testing for anti-HDV-positive ones,is *** testing can identify more HDV infection cases and link identified patients to further care and ***,laboratory-based double reflex screening is less biased than physician-led ***,health-care providers should learn about reflex testing,and federal and provincial hepatitis control programs should implement laboratory-based double reflex testing to obtain reliable HDV prevalence *** test’s cost-effectiveness depends on the number of HBV-positive patients screened to identify one HDV-positive *** testing may be viable in areas with low HBsAg but high HDV ***,its economic impact on areas with low HDV prevalence needs further study.

关键词： Anti-hepatitis D virus antibody HBsAg Hepatitis D virus RNA Hepatitis B Hepatitis D Reflex testing

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National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

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World Journal of Gastroenterology 2024年第9期30卷 1018-1042页

作者： Faisal Saud Dar Zaigham Abbas Irfan Ahmed Muhammad Atique Usman Iqbal Aujla Muhammad Azeemuddin Zeba Aziz Abu Bakar Hafeez Bhatti Tariq Ali Bangash Amna Subhan Butt Osama Tariq Butt Abdul Wahab Dogar Javed Iqbal Farooqi Faisal Hanif Jahanzaib Haider Siraj Haider Syed Mujahid Hassan Adnan Abdul Jabbar Aman Nawaz Khan Muhammad Shoaib Khan Muhammad Yasir Khan Amer Latif Nasir Hassan Luck Ahmad Karim Malik Kamran Rashid Sohail Rashid Mohammad Salih Abdullah Saeed Amjad Salamat Ghias-un-Nabi Tayyab Aasim Yusuf Haseeb Haider Zia Ammara Naveed Department of Hepatopancreatic Biliary Surgery&Liver Transplant Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Hepatogastroenterology and Liver Transplantation Dr.Ziauddin University HospitalKarachi 75600SindhPakistan University of Aberdeen Aberdeen B243FXUnited Kingdom Department of Pathology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Gastroenterology&Hepatology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Radiology Aga Khan UniversityKarachi 74800Pakistan Department of Oncology Hameed Latif HospitalLahore 54000Pakistan Division of Hepatopancreatic Biliary Surgery&Liver Transplantation Shifa International HospitalIslamabad 44000Pakistan Department of Hepatopancreatic Biliary Surgery&Liver Transplant Shaikh Zayed Hospital and Post Graduate Medical InstituteLahore 54000Pakistan Department of Medicine Aga Khan University HospitalKarachi 74800Pakistan Department of Liver Transplant Pir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Medicine&Gastroenterology Lifecare Hospital and Research CentrePeshawar 25000Khyber PakhtunkhwaPakistan Department of Hepatopancreatobiliary&Liver Transplant Bahria International HospitalLahore 54000Pakistan Department of Surgery Hepatopancreatobiliary&Liver TransplantDow University of Health SciencesKarachi 74800Pakistan Department of Gastroenterology Hepatology&NutritionPir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Oncology Dr.Ziauddin HospitalKarachi 74800Pakistan Department of Radiology Rehman Medical InstitutePeshawar 25000Pakistan Army Liver Transplant Unit Pak Emirates Military HospitalRawalpindi 46000Pakistan Department of Gastroenterology Sindh Institute of Urology and TransplantationKarachi 75500Pakistan Rashid Nursing Home and Cancer Clinic Rashid Nursing Home and Cancer ClinicRawalpindi 46000Pakistan Department of Gastroentero

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the *** Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this *** effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these *** coordinated effort can minimise delays and give patients a chance for curative treatment and effective *** diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance *** cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for ***,histopathologic confirmation is not always required before *** ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for *** only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette *** patients with unresectable hCCA can be considered for liver *** chemotherapy should be offered to patients with a high risk of *** use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary *** with acute cholangitis can be drained with endoscopic or percutaneous biliary *** chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

关键词： Hilar cholangiocarcinoma Bismuth-Corlette classification Memorial Sloan Kettering Cancer Centre Staging Preoperative biliary drainage Portal vein embolisation Surgical resection Hepatectomy

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Prevalence and Sensitivity Patterns of Candidal Infections in Various Tertiary Care Health Subunits of Karachi

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International Journal of Clinical Medicine 2018年第9期9卷 645-659页

作者： Rabeea Rizwan Zahida Memon Shehla Shaheen Faisal Afridi Mubarak Zaib Department of Pharmacology Ziauddin Medical College Karachi Pakistan Department of Microbiology Ziauddin University Hospital Karachi Pakistan

Mostly candida resides as an opportunistic organism on epithelial surfaces of human being. However, under auspicious conditions can cause infections including serious life threatening invasive candidiasis with subsequent mortality particularly in immune deficit and hospitalized patients having co-morbids. Limited data are published on the prevalence of candidiasis, based on the researches conducted at few tertiary care settings which are not representing the overall disease burden in our country, Pakistan. Therefore, this study was conducted to evaluate the frequency and sensitivity patterns of candidiasis in our community. Methods: Out of total 1020 specimens, 130 clinical samples were identified as candidal positive, obtained from March to May 2018. These samples were isolated from vagina, oropharynx, urine, tracheal aspirates, pus, blood, tips of the intubations, wounds and fluids of the body cavities. Identification of candida, its species and antifungal sensitivity screening was done by Kirby Bauer’s disk diffusion method according to CLSI guide lines’ (M - 44 A2 series, 2009). Results: A significant majority, 80 (61.5%) of candidal strains were isolated from females with female to male ratio 8:5 and most of these isolates were obtained from high vaginal swabs (43.75%). Four candidal species (Candida albicans 80%, Candida tropicalis 10%, Candida glabrata 9.2% and Candida ciferrii 0.8%) were isolated from all positive specimens. Maximum number of the positive samples 52 (40%) were obtained from ICU patients. Sensitivity test of candidal positive samples revealed that commonly used azole antifungal drugs, fluconazole and voriconazole were highly resistant, with respective 57.7% and 70.8% resistance. Conclusion: Candidiasis is highly prevalent in our clinical set up and more frequently infecting females in comparison to males as most of the positive isolates were retrieved from HVS (high vaginal swabs). Still, C. albicans was found to be the most prevalent specie

关键词： Candida Candidiasis Antifungal Drugs Fluconazole Voriconazole C. albicans Candidal Infection Sensitivity Resistance

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In-VitroComparison of Antifungal Activity of Herbs (Darehald and Pomegranate) with Azoles

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International Journal of Clinical Medicine 2018年第9期9卷 703-715页

作者： Rabeea Rizwan Shehla Shaheen Zahida Memon Faisal Afridi Mubarak Zaib Department of Pharmacology Ziauddin Medical College Karachi Pakistan Department of Microbiology Ziauddin University Hospital Karachi Pakistan

Aim: Candida, an opportunistic organism is one of the commonest causes of hospital acquired infections among fungi. Currently available antifungal drugs have numerous adverse effects and drug-drug interactions (DDIs) along with increase in resistance over the time. Therefore, it is highly emergent to consider alternative treatments for candidal infections, having fewer adverse effects and is cost-effective. The current in-vitro study is undertaken to assess and compare the antifungal effects of the herbs, Berberis aristata (B. aristata, Darehald/Darhald) and Punica granatum (P. granatum, Pomegranate) with fluconazole and voriconazole, based on culture and sensitivity of candidal isolates. Materials and Methods: Ethanolic extracts of herbs (Berberis aristata and Punica granatum) and concentrations were formulated as per standard procedure. 130 samples were obtained for the study from in and out patients reported in clinical subsets of ziauddin hospital, Karachi from March to May, 2018. Samples were collected and grown according to the standard procedures like, wet mount test and gram’s staining. Species were identified by CHROM agar candida and API 20 C AUX methods. Sensitivity tests were performed by Kirby Bauer’s disc diffusion method according to CLSI guide lines M-44 A2, 2009. Data analysis was done by one-way ANOVA to compare the antifungal activities of drugs and herbs. Results: Mean inhibitory zones of herbs, B. aristata and P. granatum were highly significant against clinical candidal isolates with respective p-values of 0.00 and 0.02. Both of the herbs, B. aristata and P. granatum were found to be more sensitive, 98.5% and 97.7% respectively in comparison to fluconazole showing 42.3% and voriconazole showing 29.2% sensitivity against candidal isolates. The most resistant candidal specie was C. tropicalis that showed resistance against both fluconazole and voriconazole, contrary to that, this specie was highly sensitive to both of the herbs, showing sensitivi

关键词： Candida Fungi Azoles Antifungal Sensitivity Antifungals Berberis aristata Punica granatum Pomegranate Darhald Darehald

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Presentation delay in breast cancer patients and its association with sociodemographic factors in North Pakistan

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Chinese Journal of Cancer Research 2015年第3期27卷 288-293页

作者： Muhammad Aleem Khan Sheharyar Hanif Sundas Iqbal Muhammad Faheem Shahzad Sehrish Shafique Muhammad Taha Khan Department of Nuclear Medicine Nuclear MedicineOncology and Radiotherapy Institute Department of Medicine Ziauddin Medical University Armed Forces Institute of Cardiology Department of Physiology Rawal Institute of Health Sciences Nuffield Brentwood hospital

Background： There is strong evidence that delayed diagnosis of breast cancer is associated with poor survival. The objectives were to determine the frequency of breast cancer patients with delayed presentation, the reasons of delay and its association with different socio-demographic variables in our ***： We interviewed 315 histologically confirmed breast cancer patients. Delay was defined as more than 3 months from appearance of symptoms to the consultation from doctor. Questions were asked from each patient which could reflect their understanding about the disease and which could be the likely reasons for their delayed ***： A total of 39.01%（n=123） of patients presented late and out of those, 40.7% wasted time using alternative medicines; 25.2% were not having enough resources; 17.1% presented late due to painless lump; 10.6% felt shyness and 6.5% presented late due to other reasons. Higher age, negative family history, 〈8 school years of education and low to middle socio-economic status were significantly associated with delayed presentation（P〈0.05）. Education and socioeconomic status were two independent variables related to the delayed presentation after adjustment for others [odds ratios（OR） of 2.26, 2.29 and 95% confidence intervals（CI） was 1.25-4.10, 1.06-4.94 respectively].Conclusions： Significant percentage of women with breast cancer in North Pakistan is experiencing presentation delay due to their misconceptions about the disease. Coordinated efforts with public health department are needed to educate the focused groups and mitigating the barriers identified in the study. Long term impact will be reduced overall burden of the disease in the region.

关键词： Breast cancer delayed diagnosis survival

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Comparison of Shisha Smoking Behavior among Medical and Pharmacy Students

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Journal of Behavioral and Brain Science 2016年第7期6卷 269-279页

作者： Ashok Kumar Salman Baig Sana Ansari Nadeem Rizvi Huma Sharif Anwar Ejaz Beg Ammara Rauf Faraz Ahmed Baig Ammara Abdul Majeed ziauddin hospital Karachi Pakistan Sindh Medical College Karachi Pakistan

Background: Health care workers are respected in every society and have a strong influence on the behaviour of the community. In order to reduce the shisha dependence in the Pakistani population, it is necessary to evaluate the perspective of future doctors and pharmacists regarding this addiction as they become role models for the future generations. Objective: The aim is to compare the knowledge, attitudes, and practices of shisha use among medical students and pharmacy students in order to assess their support in the anti-shisha campaigns of Pakistan. Methodology: Cross sectional study was performed in four major medical universities of Karachi, Pakistan through a modification of the WHO global health survey questionnaire. Result: 398 medical students and 470 pharmacy students were included in the study which showed that currently 9.6% pharmacy students and 4.8% medical students used shisha daily (p = 0.000). Pharmacy students started shisha use in less than 15 years of age while this number was 29.5% among medical students (P = 0.000). Moreover, 44.6% pharmacy students and 50% medical students were not planning to quit this addiction within the next six months. 14% of pharmacy students and 20.4% in medical students (P = 0.002) were unaware that passive smoking caused lung cancer, while 23.4% pharmacy students and 33.5% medical students rejected it as cause of heart diseases (p = 0.006). Conclusion: A significant number of medical and pharmacy students were unaware about some of the serious consequences of shisha smoking. Therefore, both groups of students need to be educated about the health hazards of shisha use, in order to control this growing menace.

关键词： Shisha Smoking Tobacco Students

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Culture and Sensitivity Patterns of Various Antibiotics Used for the Treatment of Pediatric Infectious Diarrhea in Children under 5 Years of Age: A Tertiary Care Experience from Karachi

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International Journal of Clinical Medicine 2018年第9期9卷 684-696页

作者： Faiza Quraishi Shehla Shaheen Zahida Memon Ghulam Fatima Department of Pharmacology Ziauddin Medical College Ziauddin University Karachi Pakistan Department of Microbiology Central Laboratory Civil Hospital Karachi Karachi Pakistan

Background and objective: Infectious diarrhea is one of the most common infections and a significant cause of morbidity and mortality in children under 5 years of age. Frequent and irrational use of antibiotics has resulted in increased bacterial resistance. The aim of our study was to determine the culture and sensitivity patterns of antibiotics used for the treatment of diarrhea in children less than 5 years of age in a tertiary care hospital of Karachi, Pakistan. Methodology: This cross sectional study was conducted for a period of six months in the children of ages ranging between 6 months and 5 years. Stool samples were obtained from the patients presented with signs and symptoms of diarrhea in OPD or being referred to microbiology department for stool C/S (culture and sensitivity). Data were analyzed on SPSS version 19.0. Results: A total number of 325 stool samples were collected, out of which 152 samples were positive for pathogens. The most common pathogen isolated was E. coli 92 (60%), followed by Klebsiella 56 (37%) and Salmonella 4 (3%). All 152 isolates were highly resistant to majority of the standard antibiotics. Conclusion: Infectious diarrhea is highly prevalent among children under 5 years of age. E. coli was found to be the most frequent pathogen isolated in stool samples of the patients presenting with diarrhea and was highly resistant to many of the commonly used standard antibiotics in our clinical set up. Male children were predominantly affected by infectious diarrhea as compared to female children. Therefore, injudicious use of antibiotics should be stopped as well as should not be prescribed empirically for the treatment of all cases of pediatric diarrhea.

关键词： Infectious Diarrhea Antibiotic Resistance Antibiotic Sensitivity Stool Culture

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Clinical critics in the management of diabetes mellitus

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Health 2012年第8期4卷 537-548页

作者： Syed Wasif Gillani Syed Azhar Syed Sulaiman Shameni Sundram Suzana Christopher Victor Abdul Hakim Abdullah hospital Pulau Pinang Penang Malaysia Pharmacy Department Hospital Universiti Sains Malaysia Kota Bharu Malaysia School of Pharmaceutical Sciences Universiti Sains Malaysia Penang Malaysia ziauddin College of Pharmacy Ziauddin University Karachi Pakistan

There is a global epidemic of diabetes with its prevalence expected to increase from 5.1% in 2003 to 6.3% in 2025. This increase in diabetes is occurring in all nations, however, developing nations are particularly at risk. It spares no group and affects men, women, the elderly, young and people from very racial and socio-economic background. Nevertheless, certain ethnic groups including Asians are affected more than Caucasians. Large randomized clinical trials have shown that improvement in glycaemic control, together with management of diabetes-related risk factors like blood pressure and lipid control significantly reduce the micro and macro complications in individuals with type 1 and type 2 diabetes. Patient education plays a crucial role in the prevention of diabetic fool problems. In Geneva, the rate of lower limb amputations was reduced by almost 75% after an educational intervention. People with diabetes must acquire the knowledge and skills through education to provide daily self-care in diabetes management which involves maintenance of healthy living, recognition and management of diabetes problems when they arise and taking preventive measures. Some factors include patients’ biomedical variables, the psychosocial environment, the knowledge, attitudes and beliefs of patients themselves, home careers and health care providers, healthcare systems’ accessibility and availability and even the national political context may influence these self-care behaviors.

关键词： Diabetes Mellitus Self-Care Practices Glycaemic Control Management of DM

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In-VitroComparison of Antimicrobial Actions of Probiotics (LactobacilliSpecies and Saccharomyces boulardii) with Standard Antibiotics for the Treatment of Diarrhea in Pediatric Population

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International Journal of Clinical Medicine 2018年第12期9卷 827-840页

作者： Faiza Quraishi Ghulam Fatima Shehla Shaheen Zahida Memon Samiya Kainat Faiza Agha Department of Pharmacology Ziauddin Medical College Ziauddin University Karachi Pakistan Department of Microbiology Central Laboratory Civil Hospital Karachi Karachi Pakistan Department of Biochemistry Liaquat National Medical College Karachi Pakistan

Background and objectives: Irrational and repeated use of broad spectrum antibiotics for infectious diarrhea in children has resulted in their increased resistance along with several systemic toxic effects. Probiotics are also used in the management of infectious diarrhea as these are supposed to be favorable in promoting overall health benefits including stability of the intestinal flora. However, these agents are not used as an alternative to antibiotics as their exact bactericidal/bacteriostatic effects have not been evaluated on the basis of any clinical or in-vitro samples (Culture and Sensitivity test). Hence the aim of our study was to compare the culture and sensitivity patterns of standard antibiotics and two probiotics, Lactobacilli (Lactobacillus paracasei/Lactobacillus acidophilus) and Saccharomyces boulardii used for the treatment of infectious diarrhea in children less than 5 years of age in a tertiary care hospital of Karachi, Pakistan. Methodology: This prospective quasi experimental study was conducted for a period of six months. After getting informed consent from parents/guardians, the stool samples were obtained from children of ages, 6 months to 5 years, presented with signs and symptoms of diarrhea in outpatient department (OPD) or being referred to microbiology department for stool C/S (culture and sensitivity). The sensitivity patterns of the cultured isolates were assessed for standard antibiotics according to the CLSI guidelines (2018), while the two probiotics (Lactobacilli and Saccharomyces boulardii) were evaluated by means of Dried Modification method. The data was analyzed using statistical software SPSS version 19.0. Results: A total number of 325 stool samples were collected, out of which 152 samples were positive for pathogens i.e. E. coli, Klebsiella and Salmonella typhi. The sensitivity of combination of Lactobacilli for E. coli, Klebsiella and Salmonella typhi was 28.3%, 25% and 25% respectively. While, for Saccharomyces boulardi

关键词： Antibiotics Probiotics Lactobacillus paracasei/Lactobacillus acidophilus Saccharomyces boulardii in Vitro

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