Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidit... more Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidity and mortality. Conventional hepatitis B vaccination with three doses at 0, 1, and 6 months apart is ineffective in prevention of HBV infection. To compare the efficacy of accelerated, multiple, double-dose HB vaccine with conventional HB vaccine in cancer patients receiving chemotherapy (CT). Patients of cancer who were planned for CT were screened for HBV markers (HBsAg, total anti-HB core, anti-HBs antibody and HBV DNA). Patients with negative HBV serum markers received HB vaccine in two groups. Group A received three double doses (40 μg) of recombinant HB vaccine at 0, 1, and 3 weeks before CT and additional three double doses post CT. Group B received HB vaccine (20 μg) at 0, 1, and 6 months. Efficacy of vaccine in the two groups was compared by anti-HBs titers achieved at 3, 6, and 9 months and by HBsAg positivity following CT at 1 year follow up. Protective anti-HBs titers (>10 mIU/mL) at 3, 6, and 9 months in group A and B was 41.1 %, 66.2 %, and 76 % and 26 %, 37.7 %, and 49 % respectively (p = 0.001). Seven of 454 (1.5 %) patients in group A became HBsAg positive after vaccination compared to 19/472 (4.0 %) in group B (p = 0.022). Accelerated, multiple, double-dose HB vaccine increases seroprotection and is more effective than conventional HB vaccine in preventing HBV infection.
Kashmir valley is a non endemic area for malaria due to its high altitude. However, globalization... more Kashmir valley is a non endemic area for malaria due to its high altitude. However, globalization and increased human travel has led to an increased incidence of malaria here. Further malaria can have varied presentation; therefore, a high index of suspicion is necessary especially in non endemic area. We present our experience of six patients with documented malarial infection who presented with typical clinical features of hepatitis and hence a diagnostic challenge since malaria is regarded rare in Kashmir and index of suspicion is low.
Prevalence of hepatitis B virus (HBV) infection is increased in patients of cancer with increased... more Prevalence of hepatitis B virus (HBV) infection is increased in patients of cancer with increased mortality. Multiple transfusions of blood and blood-related products are a potential source. This study aims to assess the incidence of hepatitis B surface antigen (HBsAg) seroconversion in cancer patients receiving transfusion of blood or blood-related products and identify possible reasons for infection in these patients. Patients of cancer receiving blood products, who were HBsAg-, anti-hepatitis B core (HBc)-, and HBV DNA-negative prior to transfusion, were tested for HBsAg by ELISA at 6, 12, and 24 weeks after the last transfusion. Blood donors were screened for HBsAg by ELISA. Twenty of 3,600 (0.56 %) blood donors tested positive for HBsAg and were rejected. Nine of 150 (6 %) cancer patients became HBsAg-positive posttransfusion which included seven patients who presented with acute hepatitis B and other two patients who remained HBsAg-positive without hepatitis. In 6/9 (66.6 %) patients, HBsAg positivity was related to blood transfusion as their corresponding blood donors on retesting the stored samples were positive for anti-HBc antibody and HBV DNA. In other three patients, the cause of their HBsAg positivity could not be ascertained. Occult HBV infection in blood donors is a potential source of posttransfusion HBV infection in recipients. Anti-HBc antibody and HBV DNA should be tested in blood donors especially when blood is given to cancer patients receiving chemotherapy.
A 60-year-old woman with hepatitis C-related cirrhosis and portal hypertension was admitted with ... more A 60-year-old woman with hepatitis C-related cirrhosis and portal hypertension was admitted with altered sensorium and constipation. On examination, she had encephalopathy, mild pallor and icterus, telengiactasias on the face, and palmar erythema ...
Journal of Gastroenterology and Hepatology, Apr 1, 2006
Background and Aim: Following successful endoscopic therapy in patients with peptic ulcer bleedin... more Background and Aim: Following successful endoscopic therapy in patients with peptic ulcer bleeding, rebleeding occurs in 20% of patients. Rebleeding remains the most important determinant of poor prognosis. We investigated whether or not administration of pantoprazole infusion would improve the outcome in ulcer bleeding following successful endoscopic therapy. Methods: In this double-blind, placebo-controlled, prospective trial, patients who had gastric or duodenal ulcers with active bleeding or non-bleeding visible vessel received combined endoscopy therapy with injection of epinephrine and heater probe application. Patients who achieved hemostasis were randomly assigned to receive pantoprazole (80 mg intravenous bolus followed by an infusion at a rate of 8 mg per hour) or placebo for 72 h. The primary end-point was the rate of rebleeding. Results: Rebleeding was lower in the pantoprazole group (8 of 102 patients, 7.8%) than in the placebo group (20 of 101 patients, 19.8%; P = 0.01). Patients in the pantoprazole group required significantly fewer transfusions (1 ± 2.5 vs 2 ± 3.3; P = 0.003) and days of hospitalization (5.6 ± 5.3 vs 7.7 ± 7.3; P = 0.0003). Rescue therapies were needed more frequently in the placebo group (7.8% vs 19.8%; P = 0.01). Three (2.9%) patients in the pantoprazole group and eight (7.9%) in the placebo group required surgery to control their bleeding ( P = 0.12). Two patients in the pantoprazole group and four in the placebo group died ( P = 0.45). Conclusion: In patients with bleeding peptic ulcers, the use of high dose pantoprazole infusion following successful endoscopic therapy is effective in reducing rebleeding, transfusion requirements and hospital stay.
Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidit... more Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidity and mortality. Conventional hepatitis B vaccination with three doses at 0, 1, and 6 months apart is ineffective in prevention of HBV infection. To compare the efficacy of accelerated, multiple, double-dose HB vaccine with conventional HB vaccine in cancer patients receiving chemotherapy (CT). Patients of cancer who were planned for CT were screened for HBV markers (HBsAg, total anti-HB core, anti-HBs antibody and HBV DNA). Patients with negative HBV serum markers received HB vaccine in two groups. Group A received three double doses (40 μg) of recombinant HB vaccine at 0, 1, and 3 weeks before CT and additional three double doses post CT. Group B received HB vaccine (20 μg) at 0, 1, and 6 months. Efficacy of vaccine in the two groups was compared by anti-HBs titers achieved at 3, 6, and 9 months and by HBsAg positivity following CT at 1 year follow up. Protective anti-HBs titers (>10 mIU/mL) at 3, 6, and 9 months in group A and B was 41.1 %, 66.2 %, and 76 % and 26 %, 37.7 %, and 49 % respectively (p = 0.001). Seven of 454 (1.5 %) patients in group A became HBsAg positive after vaccination compared to 19/472 (4.0 %) in group B (p = 0.022). Accelerated, multiple, double-dose HB vaccine increases seroprotection and is more effective than conventional HB vaccine in preventing HBV infection.
ud-din MBBS______________________________________________________________________ [Abstract: Bile... more ud-din MBBS______________________________________________________________________ [Abstract: Bile leaks are well known complication of hepatobiliary surgery. The present study describes the value qf combined endoscopic and radiologic techniques in the management of bile duct leaks after hepatobiliary surgery in 12 consecutive patients evaluated over a 32-month period. Fistulation occurred after cholecystectomy in 10 patients, with choledcholithotomy in 3 and after operations for hydatid cysts of the liver in 2 patients. Endoscopic retrograde cholangiography was performed3 -21 days after operation and demonstrated the site of leak from the cystic duct stump in 6 patients, the common hepatic duct in I, the common bile duct 3, and intrahepatic duct in 2. Two patients had concomitant biliary stones. Overall, 9 of the 12 patients (75%) were treated by endoscopic and ultrasonographic interventional procedures and the other 3 who had complete transection of the bile duct were treated bv surgery. Endoscopic therapeutic procedures includedsphincterotomy in 9 patients, endoprosthesis placement in 7, biliary stones extraction in 2, biliary stricture dilatation in 1, and percutaneous abscess or biloma drainage under ultrasound guidance in 6. Complete clinical improvement and healing of bile leaks were achieved in all 9 patients. Two patients developed minor complications as a result of endoscopic procedures. The results show that the combination of endoscopic with radiologic interventional techniques offers a safe, rapid and effective approach for the management of postoperative bile duct leaks'.*}
Background: Hepatitis B virus (HBV) infection is increased in cancer patients and those receiving... more Background: Hepatitis B virus (HBV) infection is increased in cancer patients and those receiving chemotherapy are at risk of HBV reactivation with high mortality. Screening for occult and overt HBV infection is not widely practiced in cancer patients. Objectives: To assess the prevalence of occult and overt HBV infection in cancer patients at initial diagnosis prior to receiving chemotherapy(CT). Methods: At initial diagnosis of cancer, patients were examined for any evidence of liver disease followed by screening for serum markers of HBV infection (HBsAg, total anti HB core, anti HBs antibody and HBV DNA). Results: Isolated anti HBsAg positivity and previous resolved HBV infection was seen in 98(14.2%) and 88/690 (12.7%) patients respectively. HBV infection was seen in 68/690(9.8%) patients which included overt and occult HBV infection in 55/690 (8%) and 13/690 (1.9%) respectively. Overt and occult HBV infection in hematological cancers was more as compared to solid cancers [16/14...
The purpose of this study was to evaluate the prevalence of celiac disease in adult patients with... more The purpose of this study was to evaluate the prevalence of celiac disease in adult patients with iron-deficiency anemia of obscure origin. One hundred and sixty-one consecutive patients with iron-deficiency anemia of obscure origin were evaluated. Tissue transglutaminase antibodies levels were done and duodenal biopsies were scored according to Marsh classification. Diagnosis was based on positive IgA anti-tissue transglutaminase antibodies and abnormal histopathology. Gluten-free diet (GFD) was adviced for celiac disease patients. One hundred and sixty healthy blood donors were tested for IgA anti-tissue transglutaminase antibodies, and positive controls were subjected to endoscopic duodenal biopsy. Tissue transglutaminase antibodies were positive in 13 (8 %) patients with iron-deficiency anemia of obscure origin and 4 (2.5 %) in control group (p = 0.026) (odds ratio 3.42; 95 % confidence interval [CI]: 1.092-10.743). All 13 patients (8 %) and 2 out of 4 positive controls (1.25 %) had histopathology findings of celiac disease (p = 0.004). Duodenal biopsy showed Marsh grade 1 in 4, grade 2 in 4 (30.77 %), 3a in 1 (7.70 %), 3b in 2 (15.38 %), and 3c in 2 (15.38 %) patients. A statistically significant correlation was found between lower hemoglobin concentration and higher Marsh grading (Spearman's rho = -0.946, p = 0.001). Celiac disease patients adhered to GFD and after 6 months mean (SD) hemoglobin levels increased from 7.42 ± 0.96 to 10.47 ± 0.80 g/dL (p- < 0.001). Patients with iron-deficiency anemia of obscure origin had increased prevalence of celiac disease. Gluten-free diet improved anemia in celiac disease patients irrespective of grade of duodenal involvement.
International Journal of Hepatobiliary and Pancreatic Diseases, 2014
ABSTRACT AbstrAct Aims: Idiopathic pancreatitis may be diagnosed once all causes of pancreatitis ... more ABSTRACT AbstrAct Aims: Idiopathic pancreatitis may be diagnosed once all causes of pancreatitis are excluded by thorough history, metabolic profile and conventional imaging modality, i.e., abdominal ultrasonography. In this study, we have attempted to evaluate the cause of idiopathic pancreatitis with the help of magnetic resonance cholangiopancreatography (MrcP). Methods: Fifty patients presenting with idiopathic pancreatitis were assessed prospectively using MrcP with strength 1.5 tesla for potential cause of the attack of pancreatitis. results: Magnetic resonance cholangiopancreatography was able to establish the cause of pancreatitis in eleven (22%) patients, as follows. common bile duct stone in one (2%), pancreatic divisum in one (2%), gallbladder stone in one (2%), pancreatic duct stone in one (2%), chronic pancreatitis in two (4%), gallbladder sludge in two (4%) and anomalous pancreaticobiliary union in three (6%) patients. conclusion: Magnetic resonance cholangiopancreatography, a non-invasive and complication free imaging modality is able to establish the cause of acute pancreatitis in patients in whom the diagnosis of idiopathic pancreatitis has been made following standard investigations. Idiopathic pancreatitis should not be diagnosed unless MrcP has been performed.. The efficacy of magnetic resonance cholangiopancreatography in assessing the etiology of acute idiopathic pancreatitis. Int J Hepatobiliary Pancreat Dis 2014;4:32–39.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associ... more Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associated with arterial oxygen desaturation, resulting in rare serious cardio-pulmonary events. To determine the severity of oxygen desaturation during nonsedated upper gastrointestinal endoscopy and study the effect of various variables on oxygen saturation. 126 patients underwent nonsedated upper gastrointestinal endoscopy (82 diagnostic, 44 therapeutic). Arterial oxygen saturation (SaO2) was monitored using a pulse oximeter. Baseline SaO2 was mean (SD) 97.8 (1.8%). It remained > 95% in 60.2% of patients during the procedure, whereas mild oxygen desaturation (SaO2 90%-94%) occurred in 23.7% and severe oxygen desaturation (SaO2 < 90%) occurred in 15.8% of patients. Six patients (4.7%) required supplemental oxygen administration sometime during the procedure. Desaturation occurred in patients undergoing diagnostic and therapeutic procedures but was severe in the latter group (p < 0.0...
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
We report a 37-year-old man with portal cavernoma who developed pericardial effusion two weeks fo... more We report a 37-year-old man with portal cavernoma who developed pericardial effusion two weeks following sclerotherapy for esophageal varices. It responded to conservative management.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
We report a 55-year-old man who developed tense ascites due to vesicoperitoneal fistula. He had u... more We report a 55-year-old man who developed tense ascites due to vesicoperitoneal fistula. He had undergone surgery 32 years ago for excision of an infected urachal cyst, the tract and the umbilicus.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Recumbency and bending are thought to provoke symptoms of reflux in patients with gastroesophagea... more Recumbency and bending are thought to provoke symptoms of reflux in patients with gastroesophageal reflux disease (GERD). The effect of exercise which involved bending and abdominal contractions was evaluated in symptomatic patients of GERD using continuous 24-hour ambulatory esophageal pH test. Twenty-five patients with GERD, confirmed by abnormal 24-hour esophageal pH study, performed exercise for 30 minutes consisting of 5 sessions of 6 minutes each. The exercise involved toe touching from supine, sitting and standing position of 2 minutes' duration each. Each 2 minutes' period included 8 repetitions of the same exercise of 15 seconds' duration. 24-hour esophageal pHmetry was done on day 1 without exercise and on day 2 with 30-minute exercise. Reflux time percent (RT%) pH <4 was compared between days 1 and 2 and 30 minutes before and during exercise. Fourteen patients were upright refluxers and 11 patients were combined refluxers, which included 4 patients with sup...
The pancreas is an infrequent site of hydatid disease. This study aims at giving better insight i... more The pancreas is an infrequent site of hydatid disease. This study aims at giving better insight into the diagnostic and managerial approach to the disease. Six patients with hydatid cysts of the pancreas. Retrospective review of the clinical records. The six patients (four men, two women) ranged in age from 18 to 68 years. Five of the cysts were primary while one had an associated cyst in the liver. Abdominal pain, vomiting, abdominal mass and dyspeptic symptoms were seen in cysts involving the body and tail. Two patients having cysts in the head of the pancreas presented with obstructive jaundice. An indirect hemagglutination test and an enzyme-linked immunoabsorbent assay were positive for the presence of specific hydatid antibodies in four patients. Abdominal ultrasonography, computed tomography and magnetic resonance cholangiopancreatography (MRCP) successfully imaged the cysts and also defined the relationship of the lesion with the pancreatic duct. All patients underwent surgi...
Left-sided hepatic resection for hepatolithiasis: a longitudinal study of 110 patients. 2012: Oma... more Left-sided hepatic resection for hepatolithiasis: a longitudinal study of 110 patients. 2012: Omar Javed Shah; Parveen Shah; Ghulam Nabi Yattoo; Showkat Ali Zargar; Gul Javaid; Irfan Robbani; Altaf Shah; Farhat Mustafa HPB : the official journal of the International Hepato Pancreato Biliary Association 2012;14(11):764-71. Abstract BACKGROUND: Hepatolithiasis affecting the left hepatobiliary system is common in the Asia Pacific region. This aim of this study was to describe an experience with the diagnosis and treatment of patients with isolated left-sided hepatolithiasis. METHODS: One hundred and ten patients with isolated left-sided hepatolithiasis who underwent a left-sided hepatic resection between January 1999 and February 2010 were included for further analysis. The clinical profile, cholangiograms, operative procedures and early and late results were examined. RESULTS: Analysis of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatogr...
Hydatid cyst of the pancreas. An experience with six cases. 2010: Omar Javed Shah; Irfan Robbani;... more Hydatid cyst of the pancreas. An experience with six cases. 2010: Omar Javed Shah; Irfan Robbani; Showkat Ali Zargar; Ghulam N Yattoo; Parveen Shah; Sadaf Ali; Gul Javaid; Altaf Shah; Bashir A Khan JOP : Journal of the pancreas 2010;11(6):575-81. Abstract CONTEXT: The pancreas is an infrequent site of hydatid disease. OBJECTIVE: This study aims at giving better insight into the diagnostic and managerial approach to the disease. PATIENTS: Six patients with hydatid cysts of the pancreas. DESIGN: Retrospective review of the clinical records. RESULTS: The six patients (four men, two women) ranged in age from 18 to 68 years. Five of the cysts were primary while one had an associated cyst in the liver. Abdominal pain, vomiting, abdominal mass and dyspeptic symptoms were seen in cysts involving the body and tail. Two patients having cysts in the head of the pancreas presented with obstructive jaundice. An indirect hemagglutination test and an enzyme-linked immunoabsorbent assay were positi...
Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidit... more Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidity and mortality. Conventional hepatitis B vaccination with three doses at 0, 1, and 6 months apart is ineffective in prevention of HBV infection. To compare the efficacy of accelerated, multiple, double-dose HB vaccine with conventional HB vaccine in cancer patients receiving chemotherapy (CT). Patients of cancer who were planned for CT were screened for HBV markers (HBsAg, total anti-HB core, anti-HBs antibody and HBV DNA). Patients with negative HBV serum markers received HB vaccine in two groups. Group A received three double doses (40 μg) of recombinant HB vaccine at 0, 1, and 3 weeks before CT and additional three double doses post CT. Group B received HB vaccine (20 μg) at 0, 1, and 6 months. Efficacy of vaccine in the two groups was compared by anti-HBs titers achieved at 3, 6, and 9 months and by HBsAg positivity following CT at 1 year follow up. Protective anti-HBs titers (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 mIU/mL) at 3, 6, and 9 months in group A and B was 41.1 %, 66.2 %, and 76 % and 26 %, 37.7 %, and 49 % respectively (p = 0.001). Seven of 454 (1.5 %) patients in group A became HBsAg positive after vaccination compared to 19/472 (4.0 %) in group B (p = 0.022). Accelerated, multiple, double-dose HB vaccine increases seroprotection and is more effective than conventional HB vaccine in preventing HBV infection.
Kashmir valley is a non endemic area for malaria due to its high altitude. However, globalization... more Kashmir valley is a non endemic area for malaria due to its high altitude. However, globalization and increased human travel has led to an increased incidence of malaria here. Further malaria can have varied presentation; therefore, a high index of suspicion is necessary especially in non endemic area. We present our experience of six patients with documented malarial infection who presented with typical clinical features of hepatitis and hence a diagnostic challenge since malaria is regarded rare in Kashmir and index of suspicion is low.
Prevalence of hepatitis B virus (HBV) infection is increased in patients of cancer with increased... more Prevalence of hepatitis B virus (HBV) infection is increased in patients of cancer with increased mortality. Multiple transfusions of blood and blood-related products are a potential source. This study aims to assess the incidence of hepatitis B surface antigen (HBsAg) seroconversion in cancer patients receiving transfusion of blood or blood-related products and identify possible reasons for infection in these patients. Patients of cancer receiving blood products, who were HBsAg-, anti-hepatitis B core (HBc)-, and HBV DNA-negative prior to transfusion, were tested for HBsAg by ELISA at 6, 12, and 24 weeks after the last transfusion. Blood donors were screened for HBsAg by ELISA. Twenty of 3,600 (0.56 %) blood donors tested positive for HBsAg and were rejected. Nine of 150 (6 %) cancer patients became HBsAg-positive posttransfusion which included seven patients who presented with acute hepatitis B and other two patients who remained HBsAg-positive without hepatitis. In 6/9 (66.6 %) patients, HBsAg positivity was related to blood transfusion as their corresponding blood donors on retesting the stored samples were positive for anti-HBc antibody and HBV DNA. In other three patients, the cause of their HBsAg positivity could not be ascertained. Occult HBV infection in blood donors is a potential source of posttransfusion HBV infection in recipients. Anti-HBc antibody and HBV DNA should be tested in blood donors especially when blood is given to cancer patients receiving chemotherapy.
A 60-year-old woman with hepatitis C-related cirrhosis and portal hypertension was admitted with ... more A 60-year-old woman with hepatitis C-related cirrhosis and portal hypertension was admitted with altered sensorium and constipation. On examination, she had encephalopathy, mild pallor and icterus, telengiactasias on the face, and palmar erythema ...
Journal of Gastroenterology and Hepatology, Apr 1, 2006
Background and Aim: Following successful endoscopic therapy in patients with peptic ulcer bleedin... more Background and Aim: Following successful endoscopic therapy in patients with peptic ulcer bleeding, rebleeding occurs in 20% of patients. Rebleeding remains the most important determinant of poor prognosis. We investigated whether or not administration of pantoprazole infusion would improve the outcome in ulcer bleeding following successful endoscopic therapy. Methods: In this double-blind, placebo-controlled, prospective trial, patients who had gastric or duodenal ulcers with active bleeding or non-bleeding visible vessel received combined endoscopy therapy with injection of epinephrine and heater probe application. Patients who achieved hemostasis were randomly assigned to receive pantoprazole (80 mg intravenous bolus followed by an infusion at a rate of 8 mg per hour) or placebo for 72 h. The primary end-point was the rate of rebleeding. Results: Rebleeding was lower in the pantoprazole group (8 of 102 patients, 7.8%) than in the placebo group (20 of 101 patients, 19.8%; P = 0.01). Patients in the pantoprazole group required significantly fewer transfusions (1 ± 2.5 vs 2 ± 3.3; P = 0.003) and days of hospitalization (5.6 ± 5.3 vs 7.7 ± 7.3; P = 0.0003). Rescue therapies were needed more frequently in the placebo group (7.8% vs 19.8%; P = 0.01). Three (2.9%) patients in the pantoprazole group and eight (7.9%) in the placebo group required surgery to control their bleeding ( P = 0.12). Two patients in the pantoprazole group and four in the placebo group died ( P = 0.45). Conclusion: In patients with bleeding peptic ulcers, the use of high dose pantoprazole infusion following successful endoscopic therapy is effective in reducing rebleeding, transfusion requirements and hospital stay.
Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidit... more Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidity and mortality. Conventional hepatitis B vaccination with three doses at 0, 1, and 6 months apart is ineffective in prevention of HBV infection. To compare the efficacy of accelerated, multiple, double-dose HB vaccine with conventional HB vaccine in cancer patients receiving chemotherapy (CT). Patients of cancer who were planned for CT were screened for HBV markers (HBsAg, total anti-HB core, anti-HBs antibody and HBV DNA). Patients with negative HBV serum markers received HB vaccine in two groups. Group A received three double doses (40 μg) of recombinant HB vaccine at 0, 1, and 3 weeks before CT and additional three double doses post CT. Group B received HB vaccine (20 μg) at 0, 1, and 6 months. Efficacy of vaccine in the two groups was compared by anti-HBs titers achieved at 3, 6, and 9 months and by HBsAg positivity following CT at 1 year follow up. Protective anti-HBs titers (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 mIU/mL) at 3, 6, and 9 months in group A and B was 41.1 %, 66.2 %, and 76 % and 26 %, 37.7 %, and 49 % respectively (p = 0.001). Seven of 454 (1.5 %) patients in group A became HBsAg positive after vaccination compared to 19/472 (4.0 %) in group B (p = 0.022). Accelerated, multiple, double-dose HB vaccine increases seroprotection and is more effective than conventional HB vaccine in preventing HBV infection.
ud-din MBBS______________________________________________________________________ [Abstract: Bile... more ud-din MBBS______________________________________________________________________ [Abstract: Bile leaks are well known complication of hepatobiliary surgery. The present study describes the value qf combined endoscopic and radiologic techniques in the management of bile duct leaks after hepatobiliary surgery in 12 consecutive patients evaluated over a 32-month period. Fistulation occurred after cholecystectomy in 10 patients, with choledcholithotomy in 3 and after operations for hydatid cysts of the liver in 2 patients. Endoscopic retrograde cholangiography was performed3 -21 days after operation and demonstrated the site of leak from the cystic duct stump in 6 patients, the common hepatic duct in I, the common bile duct 3, and intrahepatic duct in 2. Two patients had concomitant biliary stones. Overall, 9 of the 12 patients (75%) were treated by endoscopic and ultrasonographic interventional procedures and the other 3 who had complete transection of the bile duct were treated bv surgery. Endoscopic therapeutic procedures includedsphincterotomy in 9 patients, endoprosthesis placement in 7, biliary stones extraction in 2, biliary stricture dilatation in 1, and percutaneous abscess or biloma drainage under ultrasound guidance in 6. Complete clinical improvement and healing of bile leaks were achieved in all 9 patients. Two patients developed minor complications as a result of endoscopic procedures. The results show that the combination of endoscopic with radiologic interventional techniques offers a safe, rapid and effective approach for the management of postoperative bile duct leaks'.*}
Background: Hepatitis B virus (HBV) infection is increased in cancer patients and those receiving... more Background: Hepatitis B virus (HBV) infection is increased in cancer patients and those receiving chemotherapy are at risk of HBV reactivation with high mortality. Screening for occult and overt HBV infection is not widely practiced in cancer patients. Objectives: To assess the prevalence of occult and overt HBV infection in cancer patients at initial diagnosis prior to receiving chemotherapy(CT). Methods: At initial diagnosis of cancer, patients were examined for any evidence of liver disease followed by screening for serum markers of HBV infection (HBsAg, total anti HB core, anti HBs antibody and HBV DNA). Results: Isolated anti HBsAg positivity and previous resolved HBV infection was seen in 98(14.2%) and 88/690 (12.7%) patients respectively. HBV infection was seen in 68/690(9.8%) patients which included overt and occult HBV infection in 55/690 (8%) and 13/690 (1.9%) respectively. Overt and occult HBV infection in hematological cancers was more as compared to solid cancers [16/14...
The purpose of this study was to evaluate the prevalence of celiac disease in adult patients with... more The purpose of this study was to evaluate the prevalence of celiac disease in adult patients with iron-deficiency anemia of obscure origin. One hundred and sixty-one consecutive patients with iron-deficiency anemia of obscure origin were evaluated. Tissue transglutaminase antibodies levels were done and duodenal biopsies were scored according to Marsh classification. Diagnosis was based on positive IgA anti-tissue transglutaminase antibodies and abnormal histopathology. Gluten-free diet (GFD) was adviced for celiac disease patients. One hundred and sixty healthy blood donors were tested for IgA anti-tissue transglutaminase antibodies, and positive controls were subjected to endoscopic duodenal biopsy. Tissue transglutaminase antibodies were positive in 13 (8 %) patients with iron-deficiency anemia of obscure origin and 4 (2.5 %) in control group (p = 0.026) (odds ratio 3.42; 95 % confidence interval [CI]: 1.092-10.743). All 13 patients (8 %) and 2 out of 4 positive controls (1.25 %) had histopathology findings of celiac disease (p = 0.004). Duodenal biopsy showed Marsh grade 1 in 4, grade 2 in 4 (30.77 %), 3a in 1 (7.70 %), 3b in 2 (15.38 %), and 3c in 2 (15.38 %) patients. A statistically significant correlation was found between lower hemoglobin concentration and higher Marsh grading (Spearman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s rho = -0.946, p = 0.001). Celiac disease patients adhered to GFD and after 6 months mean (SD) hemoglobin levels increased from 7.42 ± 0.96 to 10.47 ± 0.80 g/dL (p- &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Patients with iron-deficiency anemia of obscure origin had increased prevalence of celiac disease. Gluten-free diet improved anemia in celiac disease patients irrespective of grade of duodenal involvement.
International Journal of Hepatobiliary and Pancreatic Diseases, 2014
ABSTRACT AbstrAct Aims: Idiopathic pancreatitis may be diagnosed once all causes of pancreatitis ... more ABSTRACT AbstrAct Aims: Idiopathic pancreatitis may be diagnosed once all causes of pancreatitis are excluded by thorough history, metabolic profile and conventional imaging modality, i.e., abdominal ultrasonography. In this study, we have attempted to evaluate the cause of idiopathic pancreatitis with the help of magnetic resonance cholangiopancreatography (MrcP). Methods: Fifty patients presenting with idiopathic pancreatitis were assessed prospectively using MrcP with strength 1.5 tesla for potential cause of the attack of pancreatitis. results: Magnetic resonance cholangiopancreatography was able to establish the cause of pancreatitis in eleven (22%) patients, as follows. common bile duct stone in one (2%), pancreatic divisum in one (2%), gallbladder stone in one (2%), pancreatic duct stone in one (2%), chronic pancreatitis in two (4%), gallbladder sludge in two (4%) and anomalous pancreaticobiliary union in three (6%) patients. conclusion: Magnetic resonance cholangiopancreatography, a non-invasive and complication free imaging modality is able to establish the cause of acute pancreatitis in patients in whom the diagnosis of idiopathic pancreatitis has been made following standard investigations. Idiopathic pancreatitis should not be diagnosed unless MrcP has been performed.. The efficacy of magnetic resonance cholangiopancreatography in assessing the etiology of acute idiopathic pancreatitis. Int J Hepatobiliary Pancreat Dis 2014;4:32–39.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associ... more Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associated with arterial oxygen desaturation, resulting in rare serious cardio-pulmonary events. To determine the severity of oxygen desaturation during nonsedated upper gastrointestinal endoscopy and study the effect of various variables on oxygen saturation. 126 patients underwent nonsedated upper gastrointestinal endoscopy (82 diagnostic, 44 therapeutic). Arterial oxygen saturation (SaO2) was monitored using a pulse oximeter. Baseline SaO2 was mean (SD) 97.8 (1.8%). It remained > 95% in 60.2% of patients during the procedure, whereas mild oxygen desaturation (SaO2 90%-94%) occurred in 23.7% and severe oxygen desaturation (SaO2 < 90%) occurred in 15.8% of patients. Six patients (4.7%) required supplemental oxygen administration sometime during the procedure. Desaturation occurred in patients undergoing diagnostic and therapeutic procedures but was severe in the latter group (p < 0.0...
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
We report a 37-year-old man with portal cavernoma who developed pericardial effusion two weeks fo... more We report a 37-year-old man with portal cavernoma who developed pericardial effusion two weeks following sclerotherapy for esophageal varices. It responded to conservative management.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
We report a 55-year-old man who developed tense ascites due to vesicoperitoneal fistula. He had u... more We report a 55-year-old man who developed tense ascites due to vesicoperitoneal fistula. He had undergone surgery 32 years ago for excision of an infected urachal cyst, the tract and the umbilicus.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Recumbency and bending are thought to provoke symptoms of reflux in patients with gastroesophagea... more Recumbency and bending are thought to provoke symptoms of reflux in patients with gastroesophageal reflux disease (GERD). The effect of exercise which involved bending and abdominal contractions was evaluated in symptomatic patients of GERD using continuous 24-hour ambulatory esophageal pH test. Twenty-five patients with GERD, confirmed by abnormal 24-hour esophageal pH study, performed exercise for 30 minutes consisting of 5 sessions of 6 minutes each. The exercise involved toe touching from supine, sitting and standing position of 2 minutes' duration each. Each 2 minutes' period included 8 repetitions of the same exercise of 15 seconds' duration. 24-hour esophageal pHmetry was done on day 1 without exercise and on day 2 with 30-minute exercise. Reflux time percent (RT%) pH <4 was compared between days 1 and 2 and 30 minutes before and during exercise. Fourteen patients were upright refluxers and 11 patients were combined refluxers, which included 4 patients with sup...
The pancreas is an infrequent site of hydatid disease. This study aims at giving better insight i... more The pancreas is an infrequent site of hydatid disease. This study aims at giving better insight into the diagnostic and managerial approach to the disease. Six patients with hydatid cysts of the pancreas. Retrospective review of the clinical records. The six patients (four men, two women) ranged in age from 18 to 68 years. Five of the cysts were primary while one had an associated cyst in the liver. Abdominal pain, vomiting, abdominal mass and dyspeptic symptoms were seen in cysts involving the body and tail. Two patients having cysts in the head of the pancreas presented with obstructive jaundice. An indirect hemagglutination test and an enzyme-linked immunoabsorbent assay were positive for the presence of specific hydatid antibodies in four patients. Abdominal ultrasonography, computed tomography and magnetic resonance cholangiopancreatography (MRCP) successfully imaged the cysts and also defined the relationship of the lesion with the pancreatic duct. All patients underwent surgi...
Left-sided hepatic resection for hepatolithiasis: a longitudinal study of 110 patients. 2012: Oma... more Left-sided hepatic resection for hepatolithiasis: a longitudinal study of 110 patients. 2012: Omar Javed Shah; Parveen Shah; Ghulam Nabi Yattoo; Showkat Ali Zargar; Gul Javaid; Irfan Robbani; Altaf Shah; Farhat Mustafa HPB : the official journal of the International Hepato Pancreato Biliary Association 2012;14(11):764-71. Abstract BACKGROUND: Hepatolithiasis affecting the left hepatobiliary system is common in the Asia Pacific region. This aim of this study was to describe an experience with the diagnosis and treatment of patients with isolated left-sided hepatolithiasis. METHODS: One hundred and ten patients with isolated left-sided hepatolithiasis who underwent a left-sided hepatic resection between January 1999 and February 2010 were included for further analysis. The clinical profile, cholangiograms, operative procedures and early and late results were examined. RESULTS: Analysis of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatogr...
Hydatid cyst of the pancreas. An experience with six cases. 2010: Omar Javed Shah; Irfan Robbani;... more Hydatid cyst of the pancreas. An experience with six cases. 2010: Omar Javed Shah; Irfan Robbani; Showkat Ali Zargar; Ghulam N Yattoo; Parveen Shah; Sadaf Ali; Gul Javaid; Altaf Shah; Bashir A Khan JOP : Journal of the pancreas 2010;11(6):575-81. Abstract CONTEXT: The pancreas is an infrequent site of hydatid disease. OBJECTIVE: This study aims at giving better insight into the diagnostic and managerial approach to the disease. PATIENTS: Six patients with hydatid cysts of the pancreas. DESIGN: Retrospective review of the clinical records. RESULTS: The six patients (four men, two women) ranged in age from 18 to 68 years. Five of the cysts were primary while one had an associated cyst in the liver. Abdominal pain, vomiting, abdominal mass and dyspeptic symptoms were seen in cysts involving the body and tail. Two patients having cysts in the head of the pancreas presented with obstructive jaundice. An indirect hemagglutination test and an enzyme-linked immunoabsorbent assay were positi...
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