Gastroenterology and Hepatology

  • EFFICIENCY OF DAA ON HCV-INFECTED KIDNEY TRANSPLANT PATIENTS AT CHO RAY HOSPITAL – VIETNAM

    Purposes:To evaluate the efficiency of DAA (Direct Antiviral Agent), in particular sofosbuvir, ledipasvir in Hepatitis C treatment for patients with kidney transplants. Take note in the side effects and drug interactions during the treatment processes. Method:Intervention, prospective, cohort, case studies, non-randomized, open on to all kidney transplant cases with chronic Hepatitis C tested positive HCV RNA (+); the patients from the cases above had agreed to be the research’s subjects from 11/2015 to 8/2018 at Cho Ray hospital. Two regimens Sofosbuvir/Ribavirin and Sofosbuvir/Ledipasvir have been used for treatments, which depend on HCV genotype and liver cirrhosis levels. Results:In 440 patients who had been observed after kidney transplants, 44 cases anti HCV (+), 29 cases HCV RNA(+) and 4 cases HBV/HCV Confection. There were 15 cases with chronic Hepatitis C participated in study. Males made up 66.6% of the group with the average age 49± 7.06 yrs. There were 6.7% of them not taking full-course treatments. 80% of the patients were infected with only C virus, while 20% of the patients were co-infected with B and C virus. 40% of them had histories of previous blood transfusions. The ratio of patients with elevated liver enzymes was 33.3%. Genotype 1 (a and b) was 33.3%, genotype 2 was 6.7%, genotype 6 was 53.3% and 6.7% unidentifiable genotype. There were 2 cases which were treated with Sofosbuvir/Ribavirin regimen and 13 cases which were treated with Sofosbuvir/Ledipasvir regimen. Rapid virologic response (RVR) is 100%. Sustained virologic response (SVR) within 12 weeks and 24 weeks is 100%. Relapse ratio 0%. In regimen using Sofosbuvir / Ledipasvir, the side effects are mild and transient, including skin irritation, digestive disorders which account for 7.7%. In regimen using Sofosbuvir / Ribavirin, side effects including severe anemia, fatigue, loss of appetite related to Ribavirin occur in 50% of cases…

  • Inflammatory bowel disease and amebiasis

    Amebiasis affects around 500 million people in the world. Clinical manifestations of intestinal amebiasis can overlap with symptoms of the inflammatory bowel disease (IBD). Many studies evaluated the relationship of IBD patients during exacerbation periods and amoebic colitis as it is important to rule out the infection before starting steroids and/or immunosuppressive treatment. This mini-review focused on the best strategy to diagnose the infection in this specific population, using classical stool analysis for ova and parasites, serology, investigations by PCR and colonoscopy according to the degree of clinical suspicion. It also suggested an algorithm for management approach where patients were divided into asymptomatic carriers vs. symptomatic patients under 5 ASA or immunosuppressive therapy having either a vegetative or cystic form of the infection. All these patients were treated accordingly by intraluminal agents, and nitroimidazole was added in the vegetative form. 5-ASA was not a contraindication for treatment, while immunosuppression is forbidden until after eradiation of EH. Amoebic infection should always be ruled out before starting treatment with steroid or immunosuppressive medications, in order to minimize its deleterious outcomes on IBD patients.

  • Study of the effect of sofosbuvir and daklatasivir on respiratory system in patients with chronic hepatitis C

    Back ground: The aim is to study effect of sofosbuvir and daklatasivir on respiratory system. Patient and methods : A randomized study was done after all patients gave an informed consent before the start. The study population consists of 21 patients receiving treatment of HCV coming to the outpatient clinic of beni suef university hospital. Results : There is no major adverse effect of sofosbuvir and daklatasivir on respiratory system as proved by assessment of pulmonary function and Computed tomography before and after treatment.

  • Liver cirrhosis with high IgG4 in a patient with, diabetes mellitus, ulcerative colitis with papillary thyroid cancer, is it all related ? which one to blame& is it time to raise awareness about IGG4 and hepatobiliary diseases

    Back ground: There is possible etiological relation between high IgG4 in a patient with liver cirrhosis, ulcerative colitis, diabetes mellitus , prostatitis ,venous thrombosis and thyroid cancers and the use of immunosuppressive & biologic agents. Method: a study of patient with multiple organ involvement with persistently elevated IgG4. A 56 years old male with persistently elevated IgG4 over 2.5 times normal level, diabetic on insulin, ulcerative colitis on azathioprin & adalimumab developed deep skin pigmentation and liver enzymes elevation with portal hypertension and liver cirrhosis, azathioprine & adalimumab were stopped and golimumab started, after 3 infusions of golimumab papillary thyroid cancer developed .Total thyroidectomy followed by radio iodine after which severe sialo adenitis developed which responded to steroids. His ulcerative colitis was treated with vedolizumab with good response. liver cirrhosis progressed with bleeding varices and portal vein thrombosis with factor Leiden V mutation. Results and conclusions: High IgG4 can be related to many organs including pancreas,liver,thyroid ,small and large bowel,parotid glands ,in this patients all these were affected resulting in colitis,diabetes,liver cirrhosis and thyroid cancer and sialo adenitis. Awareness is needed on the associations with high IgG4. Conclusion: A patient with elevated IgG4 , liver cirrhosis , diabetes mellitus, ulcerative colitis developed skin pigmentation, and papillary thyroid cancer associated with persistently elevated IgG4.

  • Domination of Gastric Complications Among Diabetic Patients

    This article covers the epidemiology, pathophysiology/complications and management of diabetic gastroparesis (DGP), and more broadly diabetic gastroenteropathy, which encompasses all the gastrointestinal manifestations of diabetes mellitus (DM). Hyperglycemia, autonomic neuropathy, and enteric neuromuscular inflammation and injury are implicated in the pathogenesis of delayed gastric emptying (GE). Initial options include dietary modifications, supplemental oral nutrition, and antiemetic and prokinetic medications. Patients with more severe symptoms may require a venting gastrostomy or jejunostomy and/or gastric electrical stimulation (GES). To date, few population-based studies have estimated the true prevalence and incidence of gastroparesis. Nonetheless, its prevalence appears to be rising, as does its incidence among minority populations, documented via hospitalizations, which can impose significant economic burdens on patients.

  • Electronic Procedural Reporting for Colonoscopy; Challenges (Discrepancies) in Data Entry and Report Generation

    Aims: Computerized reporting systems that generate standardized endoscopy reports are available and facilitate easy retrieval of data for quality assurance review. We aim to compare the accuracy of extracted database fields in our reporting system (endoPRO) for key measures of quality to the final edited endoscopy report for colonoscopy procedures. Methods: In a retrospective analysis, we compared data retrieved from endoPRO to the final colonoscopy reports at Hamilton Health Sciences (HHS). The data included demographics, indications for procedures, bowel prep quality, findings, extent of exam, and recommendations. Discrepancies, changes or missing information pertaining to key quality indicators for colonoscopies were recorded. Results: In total, 1843 colonoscopy procedures were done at HHS from January to March 2010, and reports for 592 colonoscopies, randomly selected, were analyzed for this study. Discrepancies were seen in: Indication – 34 cases (5.7%), Assistants present during colonoscopy – 94 cases (15.9%), Quality of bowel preparation – 35 cases (5.9%), Findings & impressions – 38 cases (6.4%) including polyps, inflammation, diverticulosis and haemorrhoids. Conclusions: Our study demonstrates the variability between data found in patients’ final colonoscopy reports and data retrieved from the endoscopy databases. Structured endoscopy reporting and the use of databases facilitate quality assurance but editing of procedure reports after structured data entry compromises accuracy of the data in key quality measures. Inaccurate or incomplete data recording will compromise the enhancements in quality assurance that would accrue otherwise from regular audit processes.

  • A Skipping Breakfast Everyday Keeps Well-being Away

    Breakfast, the first meal of the day, is considered the most important meal throughout the day. As nutritionist Adelle Davis famously put it back in the 1960s: “Eat breakfast like a king, lunch like a prince and dinner like a pauper”. Breakfast is most commonly skipped meal more than lunch and dinner specifically in the young adult in the university study period and those who wake up late. Lack of time is the main reason behind skipping meals, in general, lack of appetite, inability to cook, fasting/religion, and not being hungry. Many people are used to be in a hurry for job, business, children’s’ school in the morning where a filled stomach may prevent them to walk a long way. It is obvious that the irregular omission of breakfast may be effective in energy intake reduction over the next 24 hours and in this day, exercise performance may be compromised. There is no evidence that breakfast skipping reduces overeating or prevent weight gain. Some people argue that breakfast and good health is a marketing strategy by breakfast companies.

  • Phytochemical Antimicrobial Screening of Costus Afer Extract and Its Alleviation of Carbon Tetrachloride Induced Toxicity

    Plants of medicinal values contain bioactive compounds capable of preventing and combating several oxidative related diseases. Many diseases have been wrongly attended to using several medicinal plants of choice by mere instinct or sunrise. The phytochemical screening, (antimicrobial activity of Costus afer extract and its alleviation of carbon tetrachloride induced toxicity were evaluated. The phytochemical screening of both qualitative and quantitative analyses showed the presence of Tannins, Steroids, Phenols, Phytate, Hydrogen cyanide (HCN). Saponin, Alkaloids and Flavonoids in the aqueous, methanol and n-hexane stem extract. The antimicrobial activity of Costus afer extract using two different solvents showed its bactericical effect and no antibiotic effect on fungi microorganisms at different concentration. The study based on the toxicity of the substance, carbon tetrachloride showed the serum elevation of alanine aminotransferase (ALT, EC 2.6.1.2.), aspirate aminotransferase (AST, EC 2.6.1.1) and alkaline phosphase (ALT, EC 3.1.3.1) in the liver of the rabbits in response to the oral administration of the chemical. The rabbits fed with the Costus afer extract of methanol and N-hexane showed a moderate effect while the rabbits fed with the chemical carbon tetrachloride had a very high elevation on the enzymes. The rabbits, however fed with both the Costus afer and the chemical compound, carbon tetrachloride showed a considerable alleviation on the level of toxicity of the chemical. The rabbits fed with the Costus afer extract and the chemical carbon tetrachloride mixture statistically showed significant (p

  • Living Style of Diabetic Patients Type 2

    Introduction: Due to the aging process, there are disabling chronic diseases that have gained greater evidence in the public health scenario. Among them is diabetes mellitus (DM), which is one of the most common chronic diseases among the elderly. Life style is an important determinant of glycemic control in type 2 diabetic patients. Objectives: To describe the lifestyle of type 2 diabetic patients treated at the Family Health Basic Unit III, in the city of Santa Cecília-PB. Methodology: Descriptive study, population composed of 55 diabetics, adults, type 2, data collected from a pre-structured interview. Results and Discussion: 56% female, 44% male, 29% have good eating habits, 8% practice regular physical exercises, 75% are overweight, 20% are medicated. The World Health Organization considers that the diet of the diabetic is one of the factors responsible for keeping the glycemic levels within desirable limits. The survey found that only 29% of those involved have a proper diet with a very low index. Many studies suggest that sedentarism favored by modern life is a risk factor as important as inadequate diet in the etiology of obesity and has a direct and positive relationship with the increased incidence of DM 2 in adults. The practice of physical exercise for people living with diabetes is very low. Only 8% reported regular exercise. Conclusion: It is important to emphasize that glycemic control depends, in addition to drug therapy, on changes in lifestyle. Since 90% of respondents said they had good adherence to drug treatment. It is necessary to implement strategies that seek to raise awareness about the importance of lifestyle change.

  • Incidence of Diabetic Foot in Patients With Diabetes Mellitus in a Basic Health Unit

    Introduction: Diabetic neuropathy is one of the complications that integrates the pathogenic diabetic foot triad. This neuropathy leads to a foot sensory loss, making the patient vulnerable to minor injuries that could precipitate lesions, subsequent infection and foot amputation. Therefore, the diagnosis needs to come from a complete and detailed physical examination. Objective: The present study aims to investigate the incidence of diabetic foot in diabetic patients who are users of the Basic Health Unit (BHS) in the city of Olinda, Pernambuco. Methodology: The sample of this descriptive exploratory of quantitative methods study was composed of 50 diabetic users of the Basic Health Unit. After signing a Free and Informed Consent Form, a questionnaire was applied regarding the perception of the diabetic on signs and symptoms which are observed in the diabetic foot, proceeding with a thorough evaluation of the feet using 10g of monofilament and performing the Pin Prick Test. Results and Discussion: In total, 70% of patients reported poor glycemic control, 63% reported neuropathic symptoms such as numbness and tingling in the feet and 57% of the evaluated patients have thickened nails and dried or scaly feet. Regarding the vascular evaluation 47% of the evaluated presented with a decreased pedal pulse and 7% presented with this same pulse absent, while 40% had decreased posterior tibial pulse and 7% did not present any pulse at palpation. Regarding the sensitivity assessment, 30% of diabetics presented abnormal results in one of the feet and 7% had no painful and tactile reflex through the sting sensation test. Conclusion: A preventive evaluation of the feet on diabetic patients resulted in important data that informs about the high prevalence of neuropathic findings, contributing to a greater knowledge for the UBS professional team about the presence of neuropathic foot in their diabetic users.