Innovation in direct intrahepatic portosystemic shunt; a developing country experience.

Anticoagulants are the first-line treatment option for patients with Budd-Chiari syndrome (BCS); however, intervention is required when this fails. Although, the ultimate treatment is liver transplant, other radiological procedures are for the management of the disease and bridge to definitive therapy. TIPS (trans jugular intrahepatic portosystemic shunt) is a method used by interventional radiologists to create a shunt between portal vein and hepatic vein. At times it is technically not possible, in such cases, direct intrahepatic portosystemic shunt (DIPS) is performed. This patient underwent a successful DIPS procedure for BCS along with balloon dilatation (venoplasty) for inferior vena cava (IVC) stenosis.

Awareness and safe practices of Hepatitis-B and C prevention and transmission among workers of women beauty salons.

Background & Objectives: Hepatitis-B and C is currently a major health problem all over the world including Pakistan. All beauty treatments including manicures are used by many people and can be a risk factor because of sharing of contaminated instruments. Proper sterilization needs to be achieved by an autoclave. Our study was conducted to know the awareness and safe practices of Hepatitis-B and C prevention and transmission by beauty salon workers in Karachi. Methods: This was a cross-sectional descriptive study performed from February 2021- July 2021 among workers of women's beauty salons across Karachi. Validated questioners were distributed and were filled in the presence of research worker. Data was compiled and analyzed using SPSS version 22. Workers who scored ≥ 70% were considered to have adequate knowledge. Results: Our results showed that out of 261 participants, 240 (92.3%) were females. 49(18.8%) had adequate knowledge about hepatitis-B, 63(24.1%) had adequate knowledge about hepatitis-C. 111(42.5%) had adequate practices. According to the independent T test, there was statistically significant relationship between family history of hepatitis-B and knowledge of Hepatitis-B (p=0.022), hepatitis-B vaccination and knowledge of Hepatitis-B (p=0.006). We also found significant relationship between family history of hepatitis-C and knowledge of hepatitis-C (p=0.019), also between previous blood test performed for hepatitis antibodies and knowledge about hepatitis-B and C. On Uni-Variate logistic regression we found that males participants are less likely to have adequate Hepatitis-C knowledge in comparison of female participants (OR=0.152). We also found that participants who have Hepatitis-B family history, have more likely to have adequate Hepatitis-C knowledge (OR=1.874) and males participants are less likely to have adequate Hepatitis-B knowledge in comparison of female participants (OR=0.212). Only 45(17.2%) workers were fully vaccinated with Hepatitis-B and 126(48.3%) had knowledge of adequate sterilization technique of equipment's. Conclusion: This study showed that overall awareness among workers of women beauty salon in Karachi about Hepatitis-B and C is inadequate with low vaccination rates. There is dire need to organize awareness programs with mass vaccination campaigns for safe practices and to curb viral transmission.

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan.

Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan.

Comparison of fatty liver index with fibroscan in non-alcoholic fatty liver disease.

Context: Non-alcoholic fatty liver disease (NAFLD) is an escalating global health issue. Early detection and precise diagnosis are imperative for effective management. Aim: To evaluate the sociodemographic and clinical attributes of study participants concerning their ultrasound grading with FibroScan and FLI values. Settings and Design: A cross-sectional study was carried out among patients visiting gastroenterology clinics at a tertiary care hospital situated in Karachi, Pakistan. Methods and Material: We included participants after written informed consent underwent an extensive array of laboratory assessments, encompassing liver function tests, lipid profile, fasting blood sugar analysis, hepatitis B and C screening, and abdominal ultrasound, while those with positive hepatitis B or C markers, documented alcohol use, or those who declined to offer informed consent were excluded from the study. Statistical Analysis: Data were analyzed using SPSS version 26. Results: Around 225 patients were studied with a median age of 42 years (IQR = 34-50 years). Metabolic syndrome (MetS) was present in 61.8%. Steatosis was not found among 4.9% of patients, whereas severe steatosis was seen among 51.1% of patients. Significant variations in BMI, WC, GGT, and TG levels were identified when comparing FLI scores. The same was observed for the frequency of MetS as FLI scores increased. The agreement between FLI and ultrasound observations was found to be slight (k = 0.077, P = 0.027). On the multivariable regression model, having diabetes, elevated serum glutamate pyruvate transaminase levels and mild disease on ultrasound were associated with increased odds of severe steatosis. Conclusion: FLI is a good predictor of frequency of MetS and NAFLD and correlates well with increasing steatosis score (CAP) on FibroScan which can be utilized for early detection of NAFLD in primary care.

Therapeutic ERCP in patient with situs inversus totalis and ampullary diverticulum.

Situs Inversus Totalis (SIT) is a rare entity with complete transposition of all viscera, making endoscopic and surgical procedures challenging and complicated. We describe a rare case of a 55 years old man with SIT and ampullary diverticulum presenting with cholangitis and deranged liver function tests due to common bile duct stones. Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) was planned to relieve biliary obstruction and removal of stones. Procedure was started after informed consent in usual left semi-prone position but rotation of scope to 180 degrees and shortening under fluoroscopic guidance was done to attain and maintain desirable ampullary position and cannulation was done with standard sphincterotome followed by sphincterotomy and sphincteroplasty. ERCP was performed successfully despite difficulties of dual pathology and the patient made uneventful recovery.

Haemobilia: a rare cause of gastrointestinal bleeding.

Iatrogenic injury to hepatic duct leading to pseudoaneurysm and haemobilia can occur following laparoscopic cholecystectomy. We report a case of a 60 years old man presenting with haematemesis found to have pseudoaneurysm of accessory hepatic artery 4 months after laparoscopic cholecystectomy. Diagnosis was made by computed tomography (CT) scan followed by celiac and mesenteric artery angiogram. The bleeding was successfully treated with coil embolization.