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   Table of Contents - Current issue
July-September 2022
Volume 2 | Issue 3
Page Nos. 87-141

Online since Tuesday, July 5, 2022

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The erythrocyte sedimentation rate as a potential hepatocellular cancer surveillance tool p. 87
Nyam Paul David, Pantong Mark Davwar, Mary John Duguru, Jireh Dan Makpu, Atta Okwute, McHenry Ifeanyi Stephen, Edith Nonyelum Okeke
Background: There is a global search for biomarkers that will aid with the diagnosis of hepatocellular carcinoma (HCC) at an early stage when it is amenable to available treatment options. The inflammatory marker – erythrocyte sedimentation rate (ESR) has been studied for several decades for its role in inflammatory processes and malignancies. We evaluate its role as a potential surveillance tool for HCC in Jos, northern Nigeria. Objective: The study aims to determine if ESR can differentiate between patients at risk of HCC who have no liver fibrosis (patients with chronic hepatitis B infection)/liver cirrhosis, and those with HCC. Methods: This is a retrospective study among adult patients aged 18 years and above using secondary data obtained from patients who were recruited for previous studies carried out at the Jos University Teaching Hospital (From August 2019 to October 2021). HCC was confirmed using a triphasic computed tomography scan. FibroScan was carried out to determine the stage of fibrosis of the liver. The ESR rate was determined using the Westergren method. ANOVA was used to determine the difference between groups of patients. Results: There were 316 participants in this study, males were 140 (44.4%) and females were 176 (55.6%). Those with HCC were 88 (27.8%) whereas, those without HCC were 228 (72.2%). The mean age of the studied population was 47 ± 11.6 years. For those with HCC, it was 48.6 ± 13.4 years and for those without HCC, it was 47.4 ± 13.3. The mean ESR for those with HCC versus those without HCC was 60.67 ± 37.9mm/h versus 22.53 ± 8.3 mm/h, P = 0.001. ESR could discriminate between those with HCC from those without HCC, with an area under the curve of .803, sensitivity of 80%, and specificity of 67%. Conclusion: There is a need for novel methods that aid the early detection of HCC since evidence has shown that surveillance and early tumor detection improve survival. ESR is a simple, easy, and cheap test that has the potential to serve as a marker of early occurrence of HCC and should be further evaluated for this property in a prospective study.
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Fecal microbiota in inflammatory bowel disease: Studies of lactobacillus and bifidobacteria diversity p. 91
Kalpana Premkumar, Balamurugan Ramadass, Balakrishnan S Ramakrishna
Background: Diversity of microbial species is a hallmark of dysbiosis in inflammatory bowel disease (IBD). This study was undertaken to determine whether the diversity of lactobacilli and bifidobacteria, two regulatory microbial genera, is altered in patients with IBD. Methods: DNA from fecal samples of 20 healthy volunteers, 20 patients with ulcerative colitis (UC), and 25 patients with Crohn's disease (CD) was amplified by the polymerase chain reaction (PCR) for 16S ribosomal RNA gene sequences specific to genus Lactobacillus and Bifidobacterium. Real-time PCR was done to quantitate bacterial abundance. Amplified DNA was also bar coded and sequenced on the Roche 454 platform. Individual operational taxonomic units (OTUs) were taken as sequences with at least 97% similarity. Results: Abundance of Lactobacillus was significantly increased in UC compared to controls; no other difference in Lactobacillus or Bifidobacterium abundance was found between the three groups. Median reads for genus Lactobacillus was similar between control (940), UC (994), and CD (960) groups. The median number of OTUs per sample was not significantly different between controls (6), UC (5.5) and CD (7). The Shannon index of community diversity was similar between controls (median 1.12), UC (median 1.13) and CD (median 1.11). The Simpson D index was also similar between controls (median 0.393), UC (median 0.439) and CD (median 0.409). Median reads for genus Bifidobacterium was similar between control (846), UC (1052), and CD (964) groups. The median number of Bifidobacteria OTUs per sample was similar for controls (6), UC (7) and CD (8.5). The Shannon index of community diversity was similar between controls (median 0.75), UC (median 1.0) and CD (median 1.14). The Simpson D index was also similar between controls (median 0.570), UC (median 0.422) and CD (median 0.409). Conclusion: The abundance of Lactobacillus was increased in UC. Diversity of genus Lactobacillus and Bifidobacterium was not altered in either UC or CD.
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Small bowel adenocarcinoma masquerading as ileocolic intussusception p. 96
Abilash Krishna Prasad, Bhargav Varanasi, Ulagarsi Rajendran, Lawrence Dcruze, Sankar Subramanian, Jayanthi Venkataraman
Compound intussusception in the form of ileocolocolic intussusception is rare. Here we present a case of a 83 year old man who presented with abdominal pain, failed colonoscopic reduction and underwent laparotomy with resection and anastomosis. Postoperative course was uncomplicated. The final biopsy showed features of moderately differentiated adenocarcinoma of ileum.
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Hemophagocytic lymphohistiocytosis secondary to classic hodgkin lymphoma in a patient with decompensated chronic liver disease p. 99
Kartik Natarajan, Sheba Jacob, Satya Prasad, Prabhu Pandurangan, Kallipatti Ramasamy Palaniswamy
Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation. It is characterized by fever, cytopenias, splenomegaly, jaundice, neurological symptoms, and hemophagocytosis in bone marrow, liver, or lymph nodes. Secondary HLH is commonly associated with hematological malignancies, particularly non-Hodgkin lymphoma. We report a case of a patient with liver decompensation with spontaneous bacterial peritonitis and fever of unknown origin caused by malignant infiltration by classic Hodgkin lymphoma and secondary HLH. The patient was managed with modified dose of adriamycin, bleomycin, vinblastine, and dexamethasone and showed response post two cycles and is planned for two more cycles. The case highlights the importance of investigating persistent fever and accurately diagnosing and promptly treating HLH which can otherwise have a rapidly fatal course.
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Hepatitis with Syncytial Giant Cells in an Elderly Man: A Rare Histopathological Entity p. 103
Andleeb Abrari, Wajidha Perinkada Kattu, Kafil Akhtar
Giant cell transformation of hepatocytes is a nonspecific tissue reaction in neonates that is rarely seen outside of infancy. In children, it is particularly striking in cholestatic disorders and is prominent in neonatal hepatitis. In older patients, the presence of numerous hepatocyte giant cells is termed adult or postinfantile giant cell hepatitis (PIGCH) or syncytial giant cell hepatitis. About 25.0% of reported patients with PIGCH remain stable or have a gradual resolution of the disease. Corticosteroid treatment results in improvement in some but not all patients, and in the setting of autoimmune hepatitis, the clinical course may be progressive. We present a rare case of adult giant cell syncytial hepatitis with associated steatosis in a 79-year-old male, who presented with complaints of abdominal fullness, nausea, loss of appetite, and jaundice for the past 1 month.
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Primary esophageal tuberculosis: A rare presentation of a common disease p. 106
Rohan Vijay Yewale, Banumathi Ramakrishna, Karthikeyan Damodaran, Balakrishnan S Ramakrishna
Developing countries such as India, harbor almost a quarter of global tuberculosis (TB) burden. Esophageal involvement in TB, itself is a rare entity with primary esophageal TB reported only as isolated case reports. We report a case of an immunocompetent young adult who presented with dysphagia as the solitary symptom. Upper GI endoscopy and barium swallow showed a midthoracic esophageal stricture. He was subsequently diagnosed with “primary” esophageal TB based on histological examination of endoscopic biopsy showing features consistent with TB and demonstration of normal adjacent pulmonary parenchyma and lymph nodes on a computed tomography scan of the thorax. He showed marked symptomatic improvement with temporary esophageal dilation and stenting which helped in the effective administration of antituberculous therapy as well as attaining nutritional recovery. Our case report emphasizes on this rare scenario of “primary” involvement of esophagus in an otherwise common disease such as TB and its management strategy.
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Wilkie's syndrome p. 110
Arulprakash Sarangapani, Tarun J George
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Pancreatic involvement in a case of linear immunoglobulin a disease with ulcerative colitis: True or a coincidental association? p. 112
Preema Sinha, Afreen Ayub, Priyank Dhiman, Saikat Bhattacharjee, Deep Kumar Raman, Kumar Alok
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Abstracts of TNISGCON 2022 p. 115

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Gastroenterology elsewhere p. 140
Kayalvizhi Jayaraman
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