Background: Hepatitis C virus (HCV) is the major cause of liver cirrhosis, chronic liver disease, and hepatocellular carcinoma. More than 10 million individuals are living with HCV infection in Pakistan. Due to unawareness, very little information is known about HCV genotype occurrence in Punjab, the largest province of Pakistan. Identification of HCV genotype is very important for HCV treatment because different genotypes of HCV respond differently to antiviral therapy.Objective: The purpose of this research was to determine the distribution frequency of different HCV genotypes in the Punjab province and to demonstrate the distribution pattern of HCV genotypes in different age groups and sexes.Materials and Methods: In this study, we performed HCV genotyping of 3692 samples collected from different sites of the Punjab province, Pakistan. Among 3692 samples, 1755 (47.5%) were males and 1937 (52.4%) were females.Results: A total of 3692 samples were subjected to HCV genotyping and 2977 (81%) patients were genotyped successfully, whereas 715 (19%) patients were found to be HCV not detected. Our study demonstrated that among typeable genotypes, 3a constituted 2582 (69.9%) patients followed by 1a (n = 280) 7.5%, 1b (n = 64) 1.7%, 2a (n = 6) 0.16%, genotype 4 (n = 10) 0.27%, 3+4 (n = 2) 0.56%, 1a+2a (n = 11) 0.29%, 1b+2a (n = 1) 0.02%, 1a+1b (n = 1) 0.02%, and 1a+1b+3 (n = 1) 0.02% patients. HCV genotype distribution was evaluated gender wise and in different age groups like 0-12, 13-18, 19-59, and >60 years. All the HCV genotypes were equally distributed among men and women. The most affected age group was 19-59 years as compared to other age groups. Conclusion:The most frequently distributed HCV genotype in Punjab was found to be genotype 3a followed by genotype 1a, and only 0.94% of infected patients had a mixed genotype infection. Genotype 1a was found to be increasing significantly in the studied population. With these results, it can be assumed that genotype 3a may be replaced by genotype 1a with the passage of time. If this happens, this situation will be challenging in terms of antiviral therapy.

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.

No abstract

INTRODUCTION: Prediction of EV by the measurement of splenic stiffness (SS) by Transient elastography (TE) in cirrhotic patients has been recently proposed. Splenomegaly and splenic stiffness in cirrhosis can be explained by enlargement and hyper activation of the splenic lymphoid tissue, increased angiogenesis, fibrogenesis and passive congestion due to portal hypertension. Thus, the aim of this study is to assess diagnostic accuracy of spleen stiffness as a predictor for the presence of esophageal varices in liver cirrhosis using EGD as gold standard. Spleen stiffness measurement is non-invasive technique as compared to EGD so this test can be used to stratify the liver cirrhotic patient who need screening EGD compared those who do not need it. METHODS: Patients were enrolled from June 2018 to May 2019, all patient with cirrhosis undergoing screening EGD were offered to participate in the study. After fulfilling the inclusion criteria, a blood sample for platelet count, INR, CTP and MELD score was taken. Splenic stiffness was measured by fibroscan by expert radiologist prior to undergoing screening EGD. Exclusion criteria was followed strictly to avoid confounding variables. All information along including age, gender, spleen stiffness, presence or absence of EV were entered in the Performa. RESULTS: Total of 97 patients were included in the study, mean age of patients was 41.1 ± 15.1, predominantly were males 61(62.9%), while 55 (56.7%) belonged to urban areas of province. Common etiologies for cirrhosis includes HCV 49(50.5%) followed by HBV 16(16.5%), HBV and HDV coinfection 10(10.3%), autoimmune hepatitis 7(7.2%) and others were 8 (8.2%). Most patients belonged to CTP class A 58(59.8%), Mean MELD score were 11.7 ± 5.5. Mean platelets and albumin of patients were 128 ± 86.3 and 3.3 ± 0.7. Total 25 (25.7%) had ascites and 55 (56.7%) had esophageal varices on screening EGD and 6(6.2%) patient had fundal varix. Student t-test showed a significant association of low platelets (P = 0.0001, 118.3 vs 57.5) and high splenic stiffness (P = 0.0001, 37.9 vs 23.0) with the presence of esophageal varices. Area under ROC was calculated for APRI, FIB-4 and splenic stiffness was 0.81, 0.79 and 0.93 respectively. CONCLUSION: Splenic stiffness can more reliably predict the presence of esophageal varices as compare to other noninvasive test like APRI and FIB-4. So it can be used to stratify the patient who needs screening EGD and minimize the false negative results.

No abstract