A 50-year male presented with vomiting and dysphagia for 2 weeks. Laboratory workup showed a positive serology for hepatitis C and normal serum α-fetoprotein (AFP) levels. CT abdomen revealed a large lesion in the right lobe of the liver extending upto the lower esophagus causing significant luminal narrowing and dysphagia. The enhancement pattern on the CT scan was not consistent with hepatocellular carcinoma. Liver lesion biopsy showed an infiltrating spindle cell lesion exhibiting fascicles of spindle cells with moderately hyperchromatic nuclei and perinuclear vacuolization. Mitotic count was 2-3/10 HPFs. Immunohistochemical markers were positive for CK AE1/AE3 and vimentin. Thus, a diagnosis of sarcomatoid carcinoma was made on the basis of morphological and immunohistochemical features. Due to unresectable disease and poor functional status, palliative care was opted for.

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INTRODUCTION: Celiac disease and tropical sprue are common causes of chronic diarrhea & duodenal villous atrophy (DVA). Narrow band imaging (NBI) is chromoendoscopic technique which facilitates detailed visualization of the mucosal surface & allows targeted biopsy and thus increases the diagnostic yield of the biopsy specimen. Hence, we aimed to determine the diagnostic accuracy of NBI in detection of DVA using histopathology as a gold standard in chronic diarrhea patients. METHODS: All patients with diarrhea for >4weeks were enrolled. Endoscopy was performed in all the patients to take duodenal biopsy and simultaneously NBI villous pattern was noted. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and diagnostic accuracy of NBI were calculated comparing histopathology. RESULTS: Baseline characteristics are shown in Table 1. NBI findings of total patients were finger shaped (normal villi), gyriform (partial villi atrophy) and flat surface (complete villous atrophy) mucosa as 22.6%, 59.7% and 17.7% respectively. NBI has sensitivity, specificity; PPV, NPV, and diagnostic accuracy were 84.9%, 45.2%, 82.3%, 50.0%, and 75% respectively for the detection of DVA as depicted in Table 2. CONCLUSION: This study showed 93 (75%) of participants had DVA in contrast to another study from Pakistan which revealed DVA in 49.8% of patients. This disparity is likely due to difference in study population. Our patients had normal villi, partial and complete villous atrophy in 31 (25%), 72 (58.1%) & 21 (16.9%) respectively with P value 0.001. Dutta AK et al. found that NBI has sensitivity 81-87%, specificity 93%, NPV 96% and PPV 68-77% to detect DVA. We found sensitivity 85%, specificity 45%, NPV 50% & PPV 82.3%. In our study specificity & NPV were lower than in others as we included mild villous atrophy while most of the studies had a greater proportion of patients with moderate to severe villous atrophy. We found that duration of diarrhea is associated with presence of villous atrophy, as disease duration of >5 months had sensitivity 92.1% and specificity 60% while 5 months had sensitivity & specificity 80% & 31.3% respectively. This association was not observed in previous studies. So we conclude NBI is a promising technique for assessment of duodenal mucosal details in patients with longstanding chronic diarrhea.

Aim: To determine the prevelance and risk factors of gastroesophageal reflux disease among the study population Study design: A cross-sectional study Place and Duration: This study was conducted at Poonch Medical College Rawalakot AJK Pakistan from January 2020 to January 2021. Methodology: This study was conducted on a sample size of 302 people utilizing a researcher-created checklist and questionnaire. The survey was made available on the internet. The data was analyzed using SPSS version 22, which comprised the Chi-square test and descriptive statistics. Questions about increased pain intensity, food intake or not, and other signs and symptoms of reflux and factors that could increase chances of risk such as drinking coffee, smoking, spicy food, certain types of drugs, and alcohol were determined. We also inquired as to whether any investigations had been conducted. Results: The cumulative prevalence of GERD among the individuals was 61.7 percent. Significant discomfort was seen in 12 percent of the cases. Furthermore, 61.7% reported lack of appetite, 55.8% indigestion, 57% nausea and vomiting, 55.5% food regurgitation, and 41.5% chest discomfort as an associated symptom. The primary risk factors discovered were coffee consumption in 77.5%, spicy food in 58.0%, smoking in 17.1% fatty meals in 84.8%, NSAD in 24.5%, and stress in 71% participants. There was no significant difference in the occurrence of GERD based on educational level, age, employment status, marital status, or gender. Conclusion: The percentage of gastroesophageal reflux disease (61.7 percent) was extremely high. Spicy foods, coffee use, fatty meals, smoking and stress were identified as factors that increased risk. Endoscopic investigations on a population basis are advised. Keywords: gastroesophageal reflux disease, adults, spicy food, prevalence

Aim: To assess the patient Adherence and Elimination of Helicobacter pylori Infection with Once-Daily Triple Therapy versus Traditional Triple Therapy Study design: A longitudinal study Place and Duration: This study was conducted at Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat Pakistan from Faburay 2020 to February 2021. Methodology: A total of 159 patients with aggressive peptic ulcer disease were checked positive for rapid urease exam or 13C-UBT had been provided either once-daily (Tinidazole 1000 milligrams + Azithromycin 500 milligrams +Rabeprazole 40 milligrams) or twice-daily (Amoxicillin 1000 milligrams +Clarithromycin 500 milligrams +Esomeprazole 40). The fast urease exams with 13C-UBT were performed ten weeks following the end of the medication. Pill counting, standardized surveys, and interviews were used to assess compliance and side effects. Results: When compared to the twice-daily cohort, patient adherence was shown to be higher in the once-daily cohort (84.8 percent) (68.8 percent) respectively. Meanwhile, 74.6 percent of the participants tested negative for H. pylori following therapy with the once-daily prescription and reported symptomatic improvement. The standard regime, on the other hand, resulted in 68.7% of the individuals testing negative to UBT and symptomatic alleviation (p=0.4063). Conclusion: No statistically substantial variation in elimination frequencies between the two regimes was observed. The once-daily prescription, on the other hand, had improved drug adherence than the standard treatment plan, indicating that it could be a secure and a superior tolerated substitute to traditional triple treatments, particularly for patients who do not adhere to the regimen. To corroborate the findings, more research should be done. Keywords: peptic ulcer disease, adults, helicobacter pylori, azithromycin