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Nasir Khokhar

Publications and source records attributed to Nasir Khokhar.

16 recordsLinked to original sources
PubMed2005

Successful treatment of resistant chronic hepatitis C virus infection with high dose pegylated interferon.

We present the case of a 49 years old male, who was HCV RNA positive with an ALT of 260, showing no response to standard interferon (INF) plus ribavirin treatment for 48 weeks and to a further therapy with high dose standard IFN plus ribavirin for 24 weeks. Pegylated (PEG) IFN was then started at a dose of 80 mcg/week with ribavirin, but proved to be of no avail. Finally, a dose of 120 mcg/week of PEG INF and ribavirin was administered for 48 weeks. This resulted in negative HCV RNA PCR after two months and remained undetectable with normal ALT. A six-month follow-up showed a sustained viral response.

Antiviral Agents↗
PubMed2005

Acquired hepatocerebral degeneration in hepatitis C infection.

Patients with chronic liver disease (CLD) often have neurological sequelae, of which hepatic encephalopathy is the most frequent and reversible. Rare irreversible complications of CLD are acquired (non Wilsonian) hepatocerebral degeneration (AHCD) and hepatic myelopathy (HM). To our knowledge, AHCD has rarely been reported in patients with hepatitis C virus (HCV) infection. We report a patient with HCV infection who developed AHCD and resulted in serious complications.

Adult↗
PubMed2005

Treatment of chronic hepatitis B with lamivudine.

OBJECTIVE: To study the efficacy of antiviral drug lamivudine for treatment of chronic hepatitis B in Pakistani population. DESIGN: Experimental study. PLACE AND DURATION OF STUDY: A tertiary Care Center, from January 2000 to January 2004. PATIENTS AND METHODS: Patients who had positive hepatitis B surface antigen (HBsAg) and elevated ALT were recruited. Both hepatitis Be antigen (HBeAg) positive and HBeAg negative patients were included. Treatment was given with lamivudine 100mg once a day for 12 months and they were followed every 2-3 months with ALT, HBeAg, and in certain cases with, HBV DNA (PCR). Those patients who were HBeAg positive were considered to have achieved end of treatment response (ETR) when ALT was normal and HBeAg was negative and this was documented at two consecutive occasions, at least one month apart. Those patients who were HBeAg negative were considered to have achieved ETR when their ALT was normal and HBV DNA was undetectable. Patients were followed for further 6 months to evaluate for any relapse. RESULTS: A total of 105 patients were included. Eighty-two (78.1%) were males and 23 (21.9%) were females. Mean ALT of all patients was 87.15 +/- 46.01 u/dl. Seventy-two HBeAg positive and 15 HBeAg negative patients completed treatment with 23.6 % and 80.0 % response rate respectively (p <0.001). CONCLUSION: The response of lamivudine in chronic hepatitis B in Pakistani population is encouraging in HBeAg negative patients but is rather low in those who are HBeAg positive.

Adult↗
PubMed2005

Risk factors for hepatitis C virus infection in patients on long-term hemodialysis.

OBJECTIVE: To estimate the frequency of hepatitis C virus (HCV) infection in patients on hemodialysis at Shifa International Hospital and determine the association of various risk factors in the acquisition of hepatitis C infection. DESIGN: A cross-sectional analytical study. PLACE AND DURATION OF STUDY: Shifa International Hospital from January 2002 to June 2003. patients and METHODS: All patients on long-term hemodialysis in Nephrology Unit of Shifa International Hospital were studied. Their medical records were reviewed for the presence of anti-HCV in all patients. Any risk factors were noted from the patient's records and from the history of those patients who were regularly attending the dialysis unit. RESULTS: A total of 97 patients on hemodialysis were included. Out of these, 23 (23.7%) were found to be anti-HCV positive. The mean age of HCV positive patients was 55.2+/-15.5 years while for the anti-HCV negative patients it was 54.9+/-15.1 years. There were 18 (78.3%) males in the HCV positive group while 46 (62.2%) males in the HCV negative group. The mean duration of dialysis among HCV positive patients was 2.9+/-2.7 years while the mean duration of dialysis in HCV negative patients was 1.51+/-0.86 years (p-value 0.000). Anti-HCV positive group had significantly greater proportion of patients with a history of dialysis more than 2 years (43.5% vs 9.5%), adjusted odds ratio being 0.45 (95% CI 0.27-0.75). No significant difference in other risk factors between the two groups was found. When years of dialysis were treated as categorical variable, significant difference between the anti-HCV positive and negative groups was found. The risk of getting HCV was found to be significantly associated with increasing years of dialysis, (adjusted p-value 0.002). CONCLUSION: Patients on hemodialysis in our unit had 23.7% positivity of anti-HCV and history of dialysis over more than 2 years was noted to be a significant risk factor for acquisition of infection in these patients.

Female↗
PubMed2005

Psychological implications of hepatitis C virus diagnosis.

BACKGROUND AND AIMS: Hepatitis C virus (HCV) diagnosis causes significant psychological stress and anxiety. We thought it would be important to illustrate the anxiety caused by HCV diagnosis in patients from the developing world. METHODS: This study was conducted at the Shifa International Hospital, Islamabad, between February 2004 and April 2004. All patients who were recently diagnosed with HCV (those who tested positive to anti-HCV and HCV polymerase chain reaction) were given a questionnaire that compared stress due to HCV infection with four other variables, including death of a close family member, divorce, loss of source of income and move to another city. We also analyzed the anxiety level among these patients using the Beck Anxiety Inventory (BAI). RESULTS: We studied 98 patients and 100 healthy controls. Thirty-one (31.63%) patients who were diagnosed with HCV presented only with fatigue. Sixty-three (64.28%) patients admitted that diagnosis of HCV interfered with their daily life in some way. Among the newly diagnosed cases, 48 (48.97%) patients had moderate to severe anxiety (BAI Class B and C). Multi-logistic regression analysis showed that anxiety was related to HCV-related stress (P < 0.002) and self-perceived severity of disease (P < 0.001). HCV diagnosis was significantly more stressful than divorce (59.87 vs 70.95; P < 0.013), loss of source of income (50.52 vs 70.80; P < 0.001), and a move to another city (28.32 vs 70.80; P < 0.001). CONCLUSIONS: Diagnosis with HCV is reported to be more stressful than divorce, loss of source of income and a move to another city.

Adult↗
PubMed2005

Percutaneous endoscopic gastrostomy: nine years experience in a tertiary care centre in Pakistan.

OBJECTIVE: To review the experience of percutaneous endoscopic gastrostomy (PEG) tube placement and its management in the last nine years, at a tertiary care center in Pakistan. METHODS: All patients who underwent percutaneous endoscopic gastrostomy from January 1995 to January 2004 at Shifa International Hospital, Islamabad, were included in this study. The indications, technique, complications and follow up were reviewed. RESULTS: A total of 182 persons underwent this procedure. There were 118 (65.0%) males and 64 (35.0%) females. Age ranged from 55-86 years. One hundred seventy five (96.0%) patients had cerebro-vascular accident, five (2.75%) had Parkinson's disease and two (1.25%) malignancy. More than 99% procedures were successful and no procedure related mortality was noted. Mild PEG site infections were encountered in eighteen (9.8%) patients which were manageable with local treatment and oral antibiotics. Four (2.2%) patients had severe tube site infection and needed parenteral antibiotics. Tube dislodgement took place in five (2.75%) patients and had to be removed and reinserted. Thirty days follow up was uneventful with regard to the tube. Longest follow up was 736 days. CONCLUSION: Percutaneous endoscopic gastrostomy had proved a viable means of enteral nutrition in patients with neurological impairment. Complications were insignificant. However, patient and care giver's education could be improved for more effective tube management, and prevention of PEG insertion site infection.

Aged↗
PubMed2005

Treatment outcomes with long acting octreotide in inoperable hepatocellular carcinoma: a local experience and review of literature.

OBJECTIVE: To determine the efficacy of long acting octreotide (LAR) in the treatment of inoperable hepatocellular carcinoma; as well as to estimate the improvement in the quality of life. METHODS: This study was carried out at the Shifa International Hospital, Islamabad between February and September 2003. Patients were recruited after an informed consent. There were 22 patients who decided to take the medication whereas 20 patients refused due to socio-economic issues. They served as controls. The patients agreeable for treatment were administered octreotide 100 mcg subcutaneously thrice daily for two weeks. This was followed by monthly administration of 20 mg intramuscular octreotide. The patients were followed up for 6 months. Tumor size, alpha-fetoprotein levels, and improvement in quality of life (QOL) were monitored during therapy. RESULTS: Out of 22 patients, 19 patients completed the treatment. All were males. Mean age at presentation was 55 years. Tumor size regression was seen in 10 out of 22 patients (45.5%). Mean alpha-fetoprotein levels decreased in 11 out of 22 (50%) patients. An improvement in the quality of life was seen in 10 out of 22 (45.5%) patients after treatment with long acting octreotide. In the treatment arm, 14 out of 22 (64%) patients were alive at the end of six months as compared to 10 out of 20 (50%) in the control group. CONCLUSION: LAR causes tumor size regression, decreases AFP levels and improves quality of life in patients with inoperable hepatocellular carcinoma.

Antineoplastic Agents, Hormonal↗
PubMed2004

Serological profile of incidentally detected asymptomatic HBsAg positive subjects (IDAHS).

OBJECTIVE: To evaluate the serological profile of patients with incidentally detected positive hepatitis-B surface antigen (HBsAg) and to asses the risk factors. DESIGN: An observational study. PLACE AND DURATION OF STUDY: This study was conducted at Shifa International Hospital, Islamabad from 1999 to 2003. PATIENTS AND METHODS: All patients who presented to gastroenterology clinic of Shifa International Hospital, Islamabad with positive HbsAg, detected incidentally, were tested for alamine transaminase (ALT), hepatitis Beantigen (HbeAg) and in certain cases hepatitis-B virus DNA (HBV DNA) by polymerase chain reaction (PCR). Their risk factors for acquisition of infection were assessed with specific questions. RESULTS: A total of 224 patients were examined. One hundred sixty-four (73.2%) were male and 60 (26.8%) female. Mean age fo all the subjects was 32.45 -/+ 11.85 years. Out of 224 patients, 48 (21.4%) were positive for HBeAg and 176 (78.6%) were negative. Out of 48 subjects who were positive for HBeAg, 36 underwent HBV DNA determination and 32 (88.8%) were positive for HBV DNA. Out of 176 subjects who had negative HBeAg, 46 had elevated ALT and in those HBV DNA was performed and 14 had positive HBV DNA. Most common risk factors detected in these patients were intramuscular injections and surgery, however, in a large number, risk factors were unknown. CONCLUSION: Twenty-one percent asymptomatic subjects with positive HBsAg were found to be HBeAg positive. A large number of subjects with negative HBeAg had HBV DNA positive suggesting presence of precore mutants. Intramuscular injections and surgery were noted to be frequent risk factors in these subjects.

Adult↗
PubMed2004

Primary esophageal tuberculosis.

A case of primary esophageal tuberculosis in a young male is hereby reported who presented with epigastric pain and dysphagia. An esophageal ulcer was seen at 29 cm level, and tuberculosis was confirmed by the presence of caseating granulomas and Langhan's giant cells. He responded well to antituberculous treatment.

Adult↗
PubMed2004

General seroprevalence of hepatitis C and hepatitis B virus infections in population.

OBJECTIVE: To determine the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection by detection of anti-HCV and hepatitis B surface antigen (HbsAg) in general population of Pakistan. DESIGN: Observational. PLACE AND DURATION OF STUDY: Community clinic of Shifa International Hospital, Islamabad, from January 1998 to June 2004. MATERIALS AND METHODS: Sera of healthy adult individuals who presented for medical evaluation as a pre-employment criteria in the Gulf region were examined for presence of hepatitis B surface antigen and anti-HCV antibody. Alanine aminotransferase levels were also determined. RESULTS: A total of 47,538 individuals were examined. Out of these, 2528 (5.31%) were positive for anti-HCV and 1221 (2.56%) individuals had positive HBsAg. Hepatitis B surface antigen and anti-HCV both were found in 92 (0.19%) individuals. Mean age of subjects, positive for HCV antibody was 44 years and 40.5 years for HBV. Ninety-four percent individuals were males and 6% were females. Alanine aminotransferase (ALT) was normal in 56 % of subjects with positive HCV and 84% of individuals with HBV. CONCLUSION: This study which evaluated predominantly a healthy male population, showed a high seroprevalence of anti-HCV and average seroprevalence of hepatitis B virus infection. A large majority of these patients was young and had normal ALT.

Adult↗
PubMed2003

Chronic liver disease related mortality pattern in Northern Pakistan.

OBJECTIVE: To describe the mortality pattern pertaining to chronic liver disease (CLD) in Northern Pakistan. DESIGN: descriptive study. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, from August 01, 2001 to July 31, 2002. SUBJECTS AND METHODS: Twelve months admission data was reviewed from its computerized data base. All cases pertaining to medical mortality were reviewed. Out of these cases, patients of chronic liver disease were identified and their mode of presentation, severity of illness and etiology of their chronic liver disease were statistically analyzed. RESULTS: There were a total of 8529 admissions in twelve months period from August 2001 to July 2002. There were 283 (3.31%) total deaths. Out of these, 160 deaths were pertaining to medical causes. Out of these medical cases, 33 (20.6%) patients had died of chronic liver disease. Other major causes of death were cerebro-vascular accident (18.7%), malignancy (18.1%) and acute myocardial infarction (10.6%). Out of 33 patients of CLD, 12 (36%) presented with acute gastrointestinal (GI) bleeding, 9 (27%) presented with ascites and 6(18%) presented with altered mental status due to hepatic encephalopathy. Rest of them had jaundice and fever as their initial presentation. Out of these 33 patients with CLD, 23 (70%) had hepatitis C virus (HCV) as cause of their liver disease, 4 (12%) had hepatitis B virus (HBV) infection, 3 (9%) had both hepatitis B and hepatitis C virus infections and 3 (9%) had no known cause of their chronic liver disease. CONCLUSION: Chronic liver disease is a major cause of mortality in this part of Pakistan at a tertiary care hospital. HCV infection is the main cause of chronic liver disease followed by either HBV or a combination of these viruses. Major manifestations of CLD have been gastrointestinal bleeding, hepatic failure and portal hypertension.

Adult↗
PubMed2003

Endoscopic dilation of esophageal strictures.

OBJECTIVE: To review the experience of endoscopic dilation of esophageal strictures at a tertiary care hospital. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad January 1985 to January 2003. MATERIALS AND METHODS: Patients presenting with dysphagia who presented at our institution during the past 8 years were reviewed. Their etiology and the number of dilations required for improvement in dysphagia and follow up with any complications were reviewed. All procedures were performed with savary dilators using guide wire without fluoroscopy. RESULTS: A total of 369 patients were seen during this period and 583 procedures were performed. Two hundred thirty-five (63.7%) patients had peptic stricture, 123 (33.3%) had malignant strictures, 08 (2.2%) had non obstructive dysphagia and 6 (1.6%) had corrosive ingestions. The age ranged from 28-68 years. There were 254 (88.5%) males and 115 (31.2%) females. Sixty-seven (11.5%) procedures were performed as inpatient and 516 (88.5%) procedures were done as outpatient. Two to three attempts at dilatation were required to achieve satisfactory swallowing. There were no serious complication. Follow-up period was 6-8 weeks on an average. CONCLUSION: Most common esophageal stricture found in our practice were peptic strictures. Dilation with savary system was safe and effective and was able to relieve dysphagia in large number of patients. No fluoroscopic guidance was needed.

Dilatation↗
PubMedDate not supplied

Effectiveness of 48 weeks Interferon alfa-2b in combination with ribavirin as initial treatment of chronic hepatitis.

BACKGROUND: Chronic hepatitis C is a common problem worldwide and is becoming an increasingly common problem in Pakistan. This study was done to evaluate effectiveness and safety of 48 weeks combination treatment with Interferon and Ribavirin as initial therapy of chronic hepatitis C patients. METHODS: One hundred consecutive patients were prospectively evaluated and treated with combination of Interferon Alfa 2-b three million units subcutaneously three injection weekly and Ribavirin 800-1200 mg orally daily for 48 weeks and followed for another 6 months. End of the treatment, sustained viral response and side effects were noted. RESULTS: Of one hundred patients, 98 completed the treatment. There were 55 males and 43 females. Ages range from 21-60 years, mostly being 31-55 years. Over 83% responded at the end of treatment and four relapsed. Out of treated, 72.7% males and 88.3% females had sustained viral response with a total combined sustained viral response rate of 79.5%. Patients with cirrhosis had 85.7 sustained viral response. Four percent patients took longer than three months to show HCV RNA negativity. Side effects were usual and tolerable and only 2% discontinued the treatment. Non-responders were mostly males above age 50. CONCLUSION: Forty-eight weeks combination treatment with Interferon alfa 2-b and Ribavirin has given 79.5% sustained viral response in our patients and treatment was well tolerated.

Administration, Oral↗
PubMedDate not supplied

Spectrum of hepatocellular carcinoma at Shifa International Hospital, Islamabad.

BACKGROUND: The aim of this study was to review etiological and clinical features of patients with hepatocellular carcinoma (HCC) at a tertiary care centre in past nine years. Relevant data on HCC in other parts of country and world were reviewed. METHODS: Patients who had biopsy proven HCC were reviewed retrospectively. Demographic features were noted and positivity for serology. presence of cirrhosis. level of alpha-fetoprotein, tumour size and distribution of liver lesions were noted. RESULTS: A total of 67 patients were found to have biopsy proven HCC. Mean age was 58.64 +/- 12.77 years. Males were 79%. Hepatitis B surface antigen was noted to be positive in 23% of the patients, who were tested and hepatitis C antibody was found to be positive in 67% of the patients who were tested. Alpha fetoprotein level was 632.09 +/- 1332.31. Cirrhosis was noted in 69% patients. Tumour size in patients with single lesion was 6.6 +/- 1.14 cm. Patients with single lesion had 70% time involvement of the left lobe and 30% times had involvement of the right lobe. Fifty one percent of the patients in this series had multilocular distribution. CONCLUSION: Hepatocellular carcinoma has become a common tumour in Pakistan and studies are showing that this cancer is related to hepatitis C virus infection in majority of the patients. A large number of them have underlying cirrhosis and are multifocal in origin and are presented in an advanced condition.

Aged↗