BackgroundIn this study, we collated cheap and readily available non-invasive biomarkers and FibroScan score in predicting fibrosis stages in chronic hepatitis C virus (HCV) infection.MethodsWe studied 1898 patients with HCV infection confirmed by presence of HCV RNA in their serum. We compared the FibroScan score and fibrosis indices (FIs): aspartate transaminase (AST) to alanine transaminase (ALT) ratio (AAR), AST to Platelet Ratio Index (APRI), FI, fibrosis-4 (FIB-4), Age-Platelet Index (API), Pohl score, Fibrosis Cirrhosis Index (FCI). We developed a new FI, named Novel Fibrosis Index (NFI) calculated by the following formula: NFI=[(bilirubin×(ALP)2)/(platelet count (albumin)2)]−n.ResultsAAR, APRI, FI, FIB-4, API, Pohl score, FCI and NFI were able to predict fibrosis stage with correlation coefficient indices 0.848, 0.711, 0.618, 0.741, 0.529, 0.360, 0.477 and 0.26, respectively. Receiver operating characteristic curves showed sensitivity and specificity for predicting F3 by NFI=75.1% and 41.1% and F4 for NFI=72.1% and 47.1%, AAR=62.8% and 37.6%, APRI=74.6% and 87.6%, FIB-4=53.2% and 72.3%, FI=78.1% and 92.3%, API=78.1% and 60%, Pohl score=38.1% and 78.1% and FCI=78.1% and 88.1%.ConclusionsOur NFI predicted F3 and has been found to have more sensitivity and specificity in predicting F4 fibrosis stage than other FIs.

Over two hundred thousand failed Part-I English in Annual Examination conducted by eleven Boards in 2014 (Punjab, FBISE, AJK Board) (Gul, 2016). One reason of such a large scale failure may be an inappropriate content of the textbooks. The study assumed that the content of Grade XI English (Compulsory) Textbooks did not cater to the interests of the students. Qualitative and quantitative data was collected by Questionnaire from 500 randomly selected students. The analysis demonstrated that content of the subject textbooks evoked antagonistic feelings in the learners which cause failure. The study suggests that a course-content that arrests and maintains attention of learners by designing such activities as are absorbing and inspiring is mandatory to make class environment lively and learning conducive. It is high time that we upgrade the standard of our English textbooks because to be poor in English costs substantially high due to its comprehensive market.

Objectives: To determine the frequency of complications after esophageal variceal band ligation in patients of decompensated chronic liver disease. Study Design: Descriptive Case study Setting: Department of Gastroenterology Lahore General Hospital, Lahore. Period: June 2015 to June 2016. Material & Methods: In the present study, the cases of both genders and age more than 20 years having esophageal variceal of any grade on variceal screening esophagogastroduodenoscopy and duration of decompensated liver cirrhosis of at least 6 months or more were included. Esophageal variceal band ligation was performed using a multiband ligation device (Six-shooter, Wilson-Cook Inc., Winston-Salem, NC) and up to 6 bands were placed per session and next session was performed at 2 week intervals until esophageal varices were eradicated, which was defined as a complete disappearance of varices and/or the presence of a varix being too small to be ligated. All patients were followed every month regarding complications in terms of ulcer bleed and esophageal strictures. Results: In this study there were total 720 cases out of which 450 (62.5%) were males and 270 (37.5%) females. The mean age of the subjects was 33.504±4.00 years, mean duration of cirrhosis was 9.086±2.54 months and mean weight was 72.44±13.78Kg. Ulcer bleed was seen in 6.9% patients and esophageal strictures was seen in 2.5% patients. Conclusion: Complications of esophageal variceal band ligation are not that common and amongst them ulcer bleed is the salient one. Both ulcer bleed and esophageal stricture are significantly associated with varices more than 2.

Introduction: Hepatitis C has gradually become endemic in Pakistan, with infectivity rates one of the highest in the world. The emergence of direct acting antivirals (DAAs) has become a ray of sunshine in eradicating this menace from this region. The combination of sofosbuvir, daclatasvir and ribavirin (SOF/DACLA/RIBA) has had phenomenal success all over the world in eradicating this virus. Our study aims to see the effectiveness of this regime in this part of the world. Methods: After approval from the institutional review board (IRB), retrospective analysis of data of treatment naïve patients who have been treated with the above mentioned regimen was collected to assess the efficacy by calculating the sustained virological response (SVR) at 12 weeks after completion of therapy. Results: Data of 300 patients (172 females, 128 males) was collected. Mean age was 39.66 years. Majority (almost 90%) of patients were from District Multan Age range was from 18 years to 60 years. Eighty-three percent of the patients were non-cirrhotics, 15.7% had compensated cirrhosis, while only 1 % had decompensated cirrhosis. Out of the 300 patients, 291 patients had undetectable HCV RNA on polymerase chain reaction (PCR) at 12 weeks after completion of treatment, achieving SVR rates of 97%. There was no significant association of SVR rates with gender and age of patients. Conclusion: The combination of SOF/DACA/RIBA is highly efficacious for treatment of hepatitis C patients. Keywords: sofosbuvir, daclatasvir, efficacy, sustained virological response, hepatitis C

Objective: To compare the efficacy of bowel preparation with an olive oil plus low volume (2 liters) polyethylene glycol-electrolyte lavage solution (PEG-ELS) and conventional volume (4 liters) PEG-ELS solution. Study Design: Randomized, Controlled Trial. Setting: Lahore General Hospital. Period: September 2017 and November 2018. Material & Methods: Patients were randomly assigned to two groups. Group A patients were given olive oil plus low volume (2 liters) PEG-ELS and Group B patients were given conventional volume (4 liters) PEG-ELS solution. Achievement of the adequate preparation was assessed using the Boston Bowel Preparation Scale (BBPS). A questionnaire was used in assessing the ease or difficulty of ingesting the bowel-cleansing preparation. All analysis was conducted with SPSS 20.0. Results: Of the total 162 patients randomized, 24 were excluded due to various reasons. Of 138 studied patients, mean age was 40.88 ± 13.75 years, 90 (65.21%) were male and 48 (34.78%) were female. Overall, 42 (30.4%) patients had Boston Bowel Preparation Score (BBPS) 8 and 9 indicating excellent bowel preparation, 38 (27.5%) had good bowel preparation with score 6 and 7, 30 (21.7%) patients had poor bowel preparation with score 3-5, and 28 (20.3%) patients had inadequate bowel preparation with score 0-2. The mean BBPS was 6.11 ± 2.6 with the olive oil preparation and 4.63 ± 2.81 with conventional PEG-ELS preparation (P = <0.005). More patients in Olive Oil group had excellent bowel preparation as compared to conventional group (43% versus 15%, p <0.005). The mean time of examination was 23.2 minutes in Group A and 21.85 in Group B (P <0.05). Mean time for colonoscopy was much higher (28.75 min.) in patients with a BBPS score of < 3. 61%of patients in Olive Oil group experienced no side effects as compared to 43% in the conventional PEG-ELS group (p < 0.05). Abdominal pain was the most common side effect observed, more frequent in the conventional PEG-ELS group (30% versus 4.9%, p<0.05). Conclusion: Low volume PEG plus olive oil is a valid alternative and more applicable to bowel preparation for colonoscopy than conventional volume PEG, with superior efficacy, better compliance and tolerability and better safety profile.