Spirochaetes comprise a heterogenous group of gram negative, motile, spiral shaped bacteria. Some of these pathogens are known to cause numerous human diseases such as Lyme disease, relapsing fever, syphilis and leptospirosis. However, intestinal spirochetosis is a rare condition. Patients frequently present with long-term complaints of loose stools, abdominal pain and weight loss and rectal bleeding. Hence to establish a diagnosis an endoscopy with biopsy is required. In this article, we describe four such cases, having different ages and socio- economic background, successfully treated with a short course of metronidazole.

Introduction: Most of the lactate in the body is cleared in the liver. Tissue hypoxia results in increased production of lactate and decreased utility of it. Hepatic insult results not only an increase in the blood lactate levels but also is an independent prognostic marker in critically ill cirrhotic patients. Alteration of liver function is indicated by rise in serum bilirubin. The aim of this study was to therefore to assess the utility of blood lactate to Bilirubin index (LBi) in predicting mortality in patients with acute on chronic liver failure (ACLF). Methods: This prospective observational study was conducted from January 2019 to June 2021 at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation. Patients aged > 12 years and presenting ACLF were included and their baseline characteristics were recorded. Primary outcome was observed in terms of 30-days mortality and secondary outcome was six months mortality. These indices were then used to calculate the lactate to bilirubin index (LBi) as [1000 × lactate (mmol/L) × bilirubin (µmol/L)]/2. Area under Receiver operating curves (AUROC) for LBi, Child Turcotte Pugh score(CTP) and Model for End-stage Liver Disease score (MELD)  were obtained in predicting both 30 days and six months mortality  and at an optimal cutoff sensitivity, specificity and diagnostic accuracy for these scores were calculated. Results: A total number 159 patients with ACLF were included in the study. Most of the patients were young with mean age of 35.1 ±16.8 years. Males were 97(61%). Hepatitis C was the most common cause of chronic liver disease followed by hepatitis B and autoimmune hepatitis seen in 41 (25.8%), 39(24.5%) and 36 (22.6%) respectively. Hepatitis E was the most common cause of acute injury noted in 60 (37.7%) patients. The baseline characteristics showed mean serum lactate levels of 0.93±1.33 mmol/L, bilirubin levels of 258.5 ± 155.3 µmol/L, CTP score of 10.7 ± 1.8 and MELD score of 26 ±7.6. Out of 159 patients, 26 (16.4%) patients died within 30 days due to ACLF related complicaitons while 133 (83.6%) were discharged. AUROC obtained for LBi, CTP score and MELD score in predicting 30-day mortality in ACLF was 0.98, 0.79 and 0.78 respectively. A cut off of ≥11.8 for LBi Index, ≥30 for MELD score and ≥13 for CTP score were significantly associated with increased risk of 30-day mortality in ACLF patients in our population. However, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of LBi in predicting 30-day mortality was significantly higher than that of CTP and MELD score. The diagnostic accuracy of LBi in predicting 30 days mortality was 87.5%. Similarly, AUROC obtained for LBi, CTP score and MELD score in predicting 6-month mortality in ACLF was 0.89, 0.72 and 0.66 respectively and the diagnostic accuracy of LBi dropped down to 76.6% with a sensitivity of 49.28%, specificity of 97.28%, PPV of 94.4% and NPV of 71.54%.           Conclusion: Our results showed that LBi score of >11.8 had an excellent sensitivity and specificity in predicting mortality in ACLF with an excellent diagnostic accuracy in predicting one month mortality as compared to the other scores. However, its utility in predicting long term mortality is yet to be proven. Further studies are needed to validate this index.

Rectal lymphomas are of a rare occurrence. We hereby report the case of a middle aged renal transplant patient, who presented 4 years post live related renal transplantation with per rectal bleeding and on workup was found to have rectal lymphoma. Later on he underwent a battery of investigations including Lower GI endoscopy, CT scan, PET scan which confirmed his findings. He was managed with 4 cycles of rituximab and repeat PET scan showed decrease in the size of the lesion.

Hepatocellular carcinoma with portal vein thrombosis is rarely seen in young patients. Hepatitis B can lead to HCC with PVT in the absence of cirrhosis. However, it is uncommon in age less than 40 years. Here we present to you a case of an eight year old boy with a family history of hepatitis B who developed HCC with PVT.

A bstract Aim Wilson's disease (WD) is a rare autosomal recessive disease, that can involve any organ of the body, the main ones being the liver and the brain. These patients can have varied presentations, ranging from having no symptoms to having neurological manifestations to features of chronic liver disease (CLD). Those patients that end up having CLD are prognosticated via the Child–Turcotte–Pugh (CTP) score and the Model for End-stage Liver Disease (MELD) score. However, two specific scores exist for prognostication in patients having WD, namely, the Nazar score and the Dhawan score. However, these are yet to be validated nor has their use been implemented in clinical practice. Materials and methods Our study involved 65 patients with WD, comprising both the pediatric and the adult population. We aimed at evaluating the clinical manifestations the lab parameters and the management of these patients. Furthermore, we tried validating the Nazar and the Dhawan score and later compared them with the CTP and the MELD score, which are well-known prognostic tools in CLD. Results Our patients were subdivided into the pediatric (more than 50%) and the adult group. The most common presenting complaint noted in both groups was abdominal distension. Values of the urine copper and serum ceruloplasmin did not defer between the pediatric and adult patients. Hepatic involvement is frequently seen in the pediatric age-group. Also, CTP class C was chiefly seen in pediatrics 17/33 (51.5%), while CTP class B was in adults 13/32 (40.6%). The mean Nazar score was 3 ± 3, while the mean Dhawan score was 5 ± 4. The main treatment offered for both groups was zinc along with penicillamine. Conclusion Our study showed the Dhawan score was comparable to the CTP and the MELD score in terms of predicting the disease severity of WD in our patient population. How to cite this article Majid Z, Abrar G, Laeeq SM, et al . Clinical Characteristics and Comparison of Different Prognostic Scores in Wilson's Disease. Euroasian J Hepato-Gastroenterol 2022;12(2):69–72.