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Papers by Nasir Luck

Experimental and Clinical Transplantation, 2019

OBJECTIVES Direct-acting antiviral agents have recently been recommended in renal transplant reci... more OBJECTIVES Direct-acting antiviral agents have recently been recommended in renal transplant recipients. Considering our previous encouraging responses with combined sofosbuvir and ribavirin in renal transplant recipients and the availability of daclatasvir, we aimed to evaluate the effectiveness and safety of sofosbuvir-based direct-acting antiviral agents in our population. MATERIALS AND METHODS All renal transplant recipients who received sofosbuvir-based direct-acting antivirals from August 2015 to March 2018 were included in our study. Patients were treated with sofosbuvir and ribavirin for 24 weeks or with combined sofosuvir, daclatasvir, and ribavirin for 12 weeks. Patient demographics and baseline laboratory parameters were collected. Rapid virologic response, end of treatment response, and sustained virologic response at 12 weeks were analyzed. Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 20.0, IBM Corporation, Armonk, NY, USA). RESULTS In our study group of 79 patients, mean age was 36.5 ± 10.2 years and 60 were men (78.5%). Fiftysix patients (70.9%) were treatment naive; of the remaining patients, 20 received interferon before transplant and 3 were treated with sofosbuvir and ribavirin after renal transplant. Genotype 1 was observed in 42 patients (53.2%), whereas mixed genotype (1 and 3) was shown in 10 patients (12.6%). Sixty-two patients (78.5%) received sofosbuvir and ribavirin, and 17 patients (21.5%) received sofosbuvir, daclatasvir, and ribavirin. End of treatment response was achieved in 78 recipients (98.1%). Anemia was observed in 13 patients (16.4%). CONCLUSIONS Hepatitis C virus was successfully eradicated in renal transplant recipients who received a combination of sofosbuvir plus ribavirin or sofosbuvir, daclatasvir, and ribavirin. These combinations were effective and well tolerated in our study population, even in those with mixed genotype, with no major adverse events.

Journal of translational internal medicine

To evaluate the clinical presentation, possible etiological factors, management and outcome of pa... more To evaluate the clinical presentation, possible etiological factors, management and outcome of patients in our hospital with extrahepatic portal vein obstruction (EHPVO). This study included patients with EHPVO followed up in our department during last 10 years. Patients of cirrhosis with EHPVO were excluded. Patients' clinical presentation, etiology of EHPVO, management and outcome results were analyzed. Of 30 patients, 19 (67.9%) were males. Median age was 12 years. Of 14 patients who underwent liver biopsy 9 had histological activity index stage of 1/6. History of omphalitis and pulmonary tuberculosis was present in one case each. Of 22 patients with the available thrombophilia profile, nine patients had a deficiency of protein C, five patients had a deficiency of protein S, one each had reduced level S of anti-thrombin III and factor V mutation. The predominant presenting symptom was hematemesis (15 patients, 53.6%). Seven patients (25%) had splenomegaly. Three patients (10....

Journal of Pharmaceutical Research International

Introduction: Numerous obesity indices have been developed that predict non-alcoholic fatty liver... more Introduction: Numerous obesity indices have been developed that predict non-alcoholic fatty liver disease (NAFLD). We in our study aimed at evaluating a few of these tools including waist to height ratio (WHtR), waist circumferences (WC), body mass index (BMI) and fatty liver index (FLI) and used them to determine their ability in diagnosing NAFLD. Methods: This cross sectional study was conducted at the outpatients’ department of our hospital. NAFLD was diagnosed on the basis of ultrasound abdomen. Anthropometric parameters like Height (in), weight(cm), WC (cm), BMI, WHtR were calculated and later the FLI (comprising of BMI,WC, triglyceride and gamma glutamyl transferase) was calculated. The Receiver operating characteristic analysis (ROC) was then conducted to determine the discriminatory ability and related cut-off points and a P value of ≤0.05 was taken as statiscally significant. Results: A total of 300 participants were included and the prevalence of NAFLD was 44.8% in men and...

Supplemental material, sj-docx-1-tdo-10.1177_00494755211049031 for Intestinal Spirochaetosis-A ca... more Supplemental material, sj-docx-1-tdo-10.1177_00494755211049031 for Intestinal Spirochaetosis-A case series from the developing world by Zain Majid, Ghazi Abrar, Hina Ismail, Muhammad Danish, Muhammad Mubarak and Nasir Luck in Tropical Doctor

Supplemental material, sj-docx-2-tdo-10.1177_00494755211049031 for Intestinal Spirochaetosis-A ca... more Supplemental material, sj-docx-2-tdo-10.1177_00494755211049031 for Intestinal Spirochaetosis-A case series from the developing world by Zain Majid, Ghazi Abrar, Hina Ismail, Muhammad Danish, Muhammad Mubarak and Nasir Luck in Tropical Doctor

American Journal of Gastroenterology, 2021

Introduction: Endoscopic Ultrasound Elastography (EUS-EG), has emerged as a useful modality in es... more Introduction: Endoscopic Ultrasound Elastography (EUS-EG), has emerged as a useful modality in estimating tissue stiffness. Second generation techniques for elastography assessment allow quantitative measurements of average elasticity of a lesion. The strain ratio (SR) elastography is a semiquantitative measure of elastography patterns. This ratio is calculated by comparing the elastography patterns of the targeted lymph nodes (LN) to those of a nearby reference tissue. With help of this study we can improve diagnostic accuracy of EUS-EG in evaluation of malignant LN. The objective of this study is to assess the specificity, sensitivity and predictive values of the stain ratio (SR) measured by EUS-EG in differentiating benign from malignant lymph nodes (LNs). Methods: This prospective study included 106 patients with Abdominal/Mediastinal lymphadenopathy. Second generation EUS-EG was performed, in addition to detailed assessment of sonographic features of LN including: size, diameter, character, shape, echotexture (echogenic or echopoor) and hilum (lost or preserved). Strain ratio was calculated by EUS-EG ((Pentax EG-3830UT Echo-endoscope, HOYA Corporation, PENTAX Lifecare Division, Hitachi EUB-7000 ). Strain Ratio cut off was calculated on basis of receiver operating characteristic (ROC) curve analysis. Results: Majority of study population were males: 64 (60.4%).Mean age of 46.3 6 15.5 years. Mean size of lymph nodes was 22.2 6 7.7 mm and mean strain ratio was 61.9 6 46.3. In total 36 (34 %) patients had malignant lymphadenopathy on histopathology in which 88.8% were found to be hard on elastography. At cut off 27, strain ratio demonstrated sensitivity, specificity, positive and negative predictive values of 80.5 %, 58.7 %, 85.2% and 66.04%, respectively with area under the ROC (AUROC) of 0.72.On multivariate analysis, higher strain ratio (p50.002) and lymph node size 20mm(p5,0.001)werefoundtobesignificantlyassociatedwithpresenceofmalignantdisease.Conclusion:Althoughhistologyremainsthegoldstandardfordiagnosis,EUS−EGstrainratioisausefultechniquetopredictmalignancyinrestrainedsettingswherebiopsyisnotpossiblewhichincludes;vascularproximityand/chancesofseedling.Moreover,Strainratiocanalsobeutilizedindiseasestaging.Wedemonstratedthatlymphnodesize20 mm (p5, 0.001) were found to be significantly associated with presence of malignant disease. Conclusion: Although histology remains the gold standard for diagnosis, EUS-EG strain ratio is a useful technique to predict malignancy in restrained settings where biopsy is not possible which includes; vascular proximity and/ chances of seedling. Moreover, Strain ratio can also be utilized in disease staging. We demonstrated that lymph node size 20mm(p5,0.001)werefoundtobesignificantlyassociatedwithpresenceofmalignantdisease.Conclusion:Althoughhistologyremainsthegoldstandardfordiagnosis,EUS−EGstrainratioisausefultechniquetopredictmalignancyinrestrainedsettingswherebiopsyisnotpossiblewhichincludes;vascularproximityand/chancesofseedling.Moreover,Strainratiocanalsobeutilizedindiseasestaging.Wedemonstratedthatlymphnodesize 20 mm and EUS-EG strain ratio $ 27.1, has higher likelihood of malignancy.

American Journal of Gastroenterology, 2021

American Journal of Gastroenterology, 2021

Hina Ismail, MBBS1, Raja Taha Yaseen, MBBS2, Syed Mudassir Laeeq, MBBS, FCPS (Med)2, Farina Hanif... more Hina Ismail, MBBS1, Raja Taha Yaseen, MBBS2, Syed Mudassir Laeeq, MBBS, FCPS (Med)2, Farina Hanif, MBBS, FCPS1, Zain Majid, MBBS, FCPS (Gastro)2, Muhammad Adeel Farooq, MBBS2, Abbas Ali Tasneem, MBBS, FCPS (Med), FCPS (Gastro)2, Nasir Luck, MBBS, FCPS (Med), FCPS (Gastro)2, Kiran Bajaj, MBBS, FCPS2. Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan; Sindh institute of Urology and Transplantation, Karachi, Sindh, Pakistan.

American Journal of Gastroenterology, 2021

American Journal of Gastroenterology, 2020

Journal of Preventive Epidemiology, 2021

Human immunodeficiency virus (HIV) is an infectious disease that is rarely seen in ulcerative col... more Human immunodeficiency virus (HIV) is an infectious disease that is rarely seen in ulcerative colitis patients. Both diseases commonly involve the colon. It has been shown that treating these patients with anti-tumor necrosis factor (anti-TNF) therapy leads to remission of both conditions. We hereby present the case of a 7-year-old boy who was initially managed as a case ulcerative colitis after undergoing extensive workup and later on tested positive for HIV infection and was managed via mesalamine and highly active antiretroviral therapy (HAART). Mesalamine therapy along with HAART can be used to treat ulcerative colitis patients infected with HIV infection in resource limited countries.

American Journal of Gastroenterology, 2020

American Journal of Gastroenterology, 2017

American Journal of Gastroenterology, 2018

97 HBV+ were followed at Liver Associates of Texas Hepatology clinics and started on TAF treatmen... more 97 HBV+ were followed at Liver Associates of Texas Hepatology clinics and started on TAF treatment and followed. Lab values were taken before initiation of TAF therapy and then during 3, 6, and 9-month follow-up visits. Patients' baseline labs before starting the TAF medication served as their own control. Clinical variables considered included creatinine, eGFR (an estimate of creatinine clearance), transaminases, phosphorous, and magnesium levels. A paired-two sample mean t-test was performed on each of these variables with a significance level of 0.05. Results: 97 patients previously diagnosed with chronic HBV were studied; 67% were previously being treated with TDF, 10% previously with entecavir (ETV), 1% with adefovir dipivoxil, 6% were treatment naïve, 4% had an unknown previous treatment, and 11% with a combination of these antivirals. 62 (64%) were male, mean age 51±13, BMI: 24±4.6, 51% Asians, 19% African Americans, 4% Caucasians, 2% Hispanics, 23% other ethnicity. No significant difference was found between the creatinine, eGFR, AST, LFT, phosphorus, or magnesium levels of patients before or after treatment with TAF at either the 3-month, 6-month, and 9-month follow-up appointments. Conclusion: The results of this study supports those of previous studies that renal and liver functions are preserved in the short term when patients are treated with TAF. No significant differences were identified in the creatinine, GFR, ALT, AST, phosphorus, or magnesium levels of patients before or after treatment with TAF for 3, 6, or 9 months. This study reinforces a favorable safety profile in our HBV patients during this time period. Thus TAF has minimal or no renal and other organ toxicities in the short term.

American Journal of Gastroenterology, 2018

Journal of translational internal medicine, 2018

Gastrointestinal symptoms are common in patients with end stage renal disease (ESRD) among which ... more Gastrointestinal symptoms are common in patients with end stage renal disease (ESRD) among which dyspepsia is frequently observed. The aim of the study was to determine the frequency and associations of dyspepsia in ESRD patients using the Leeds questionnaire. All ESRD patients on maintenance hemodialysis were consecutively enrolled in the study. Leeds questionnaire was used to interrogate the patients for the assessment of dyspepsia. Mean and standard deviation were calculated for age, body mass index (BMI), disease duration and number of hemodialysis sessions. Independent t-test and Chi square tests were used for statistical analysis. Total number of patients was 200, out which 118 (59.3%) were male. The mean age was of 41.4 years. According to the Leeds questionnaire, dyspepsia was present in 62 (63.9%) patients. Younger patients (age 20-40 years) more frequently had dyspeptic symptoms (61.5% patients), retrosternal pain (156 patients, 78.0%), regurgitation (127 patients, 63.5%),...

Tropical Doctor, 2021

Spirochaetes comprise a heterogenous group of gram negative, motile, spiral shaped bacteria. Some... more 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.

American Journal of Gastroenterology, 2021

Introduction: Appropriate bowel preparation is cornerstone for detection of pathology during colo... more Introduction: Appropriate bowel preparation is cornerstone for detection of pathology during colonoscopy. The ideal preparation should not only ensure proper visualization of colonic mucosa but also should be tolerable and in-expensive. Both oral sodium phosphate containing and polyethylene glycol-based lavage are used predominantly as bowel cleansing modalities. Hence, we aim to assess the efficacy and tolerability of the two bowel preparation regimens for colonoscopy. Methods: Patients were randomized into two groups, Group 1; polyethylene glycol (PEG) (236 gm in two liter water in two divided doses) and Group 2 received sodium phosphate (NaP) (90 ml in two divided doses). Endoscopist was blinded to the type of preparation. Efficacy was measured by using Boston Bowel Preparation Scale (BBPS) scale. BBPS score more than 6 was labelled as optimum preparation. Tolerability was assessed by symptoms; nausea, abdominal pain, vomiting and abnormal taste. Results: In total 102 patients ; 58 (56.9%) were males . The mean age was 44.596 13.9 years and mean weight was 57.63 6 12.6 kg. NaP preparation was used in 53 (52%) while PEG based preparation in 49 (48%) patients, respectively. Median BBPs score was 7. Majority of study population (72.5%) had optimum preparation. In comparison to NaP preparation, patients with PEG based coloprep had BBPS score of $ 6 (P 5 0.02). Patient became nauseated (P 5 0.05) and developed altered taste (P # 0.001) with NaP preparation. While solution tolerability was better with PEG based preparation. (P # 0.001). Conclusion: Colonoscopy preparation is more efficacious and well tolerable with polyethylene glycol-based lavage as compared to sodium phosphate containing solution.

Journal of Preventive Epidemiology, 2021

Lymphomas are rarely associated with liver disease. We hereby present a case of anaplastic T cell... more Lymphomas are rarely associated with liver disease. We hereby present a case of anaplastic T cell lymphoma in a 45-year-old female, who had received four cycles CHOP chemotherapy regimen and was evaluated for abdominal pain, fever along with weight loss. She was later found to have features of chronic liver disease on ultrasound along with varices on screening endoscopy. Serological workup was positive for hepatitis C infection while her liver biopsy showed features of autoimmune hepatitis. She was managed with steroids and azathioprine along with direct acting antiviral agents.

Immunopathologia Persa, 2017

A middle aged male presented with abdominal distension since one month. Further workup showed pla... more A middle aged male presented with abdominal distension since one month. Further workup showed plasma hemoglobin of 18.1 g/dL with a high pack cell volume (PCV), raised urea, creatinine and disturbed liver function tests. Abdominal ultrasonography showed an enlarged caudate lobe with thrombi in the inferior vena cava while CT scan of abdomen confirmed the same findings and was suggestive of Budd-Chiari syndrome. Further workup was conducted to rule out other causes and to find out the possible cause of Budd-Chiari syndrome. A peripheral film was requested, which showed hyper-segmented neutrophils. Later on JAK2 mutation and thrombophilia profile was ordered, which was positive for JAK2 mutation. Even though the patient was started on low molecular weight heparin but he eventually passed away.

Experimental and Clinical Transplantation, 2019

OBJECTIVES Direct-acting antiviral agents have recently been recommended in renal transplant reci... more OBJECTIVES Direct-acting antiviral agents have recently been recommended in renal transplant recipients. Considering our previous encouraging responses with combined sofosbuvir and ribavirin in renal transplant recipients and the availability of daclatasvir, we aimed to evaluate the effectiveness and safety of sofosbuvir-based direct-acting antiviral agents in our population. MATERIALS AND METHODS All renal transplant recipients who received sofosbuvir-based direct-acting antivirals from August 2015 to March 2018 were included in our study. Patients were treated with sofosbuvir and ribavirin for 24 weeks or with combined sofosuvir, daclatasvir, and ribavirin for 12 weeks. Patient demographics and baseline laboratory parameters were collected. Rapid virologic response, end of treatment response, and sustained virologic response at 12 weeks were analyzed. Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 20.0, IBM Corporation, Armonk, NY, USA). RESULTS In our study group of 79 patients, mean age was 36.5 ± 10.2 years and 60 were men (78.5%). Fiftysix patients (70.9%) were treatment naive; of the remaining patients, 20 received interferon before transplant and 3 were treated with sofosbuvir and ribavirin after renal transplant. Genotype 1 was observed in 42 patients (53.2%), whereas mixed genotype (1 and 3) was shown in 10 patients (12.6%). Sixty-two patients (78.5%) received sofosbuvir and ribavirin, and 17 patients (21.5%) received sofosbuvir, daclatasvir, and ribavirin. End of treatment response was achieved in 78 recipients (98.1%). Anemia was observed in 13 patients (16.4%). CONCLUSIONS Hepatitis C virus was successfully eradicated in renal transplant recipients who received a combination of sofosbuvir plus ribavirin or sofosbuvir, daclatasvir, and ribavirin. These combinations were effective and well tolerated in our study population, even in those with mixed genotype, with no major adverse events.

Journal of translational internal medicine

To evaluate the clinical presentation, possible etiological factors, management and outcome of pa... more To evaluate the clinical presentation, possible etiological factors, management and outcome of patients in our hospital with extrahepatic portal vein obstruction (EHPVO). This study included patients with EHPVO followed up in our department during last 10 years. Patients of cirrhosis with EHPVO were excluded. Patients' clinical presentation, etiology of EHPVO, management and outcome results were analyzed. Of 30 patients, 19 (67.9%) were males. Median age was 12 years. Of 14 patients who underwent liver biopsy 9 had histological activity index stage of 1/6. History of omphalitis and pulmonary tuberculosis was present in one case each. Of 22 patients with the available thrombophilia profile, nine patients had a deficiency of protein C, five patients had a deficiency of protein S, one each had reduced level S of anti-thrombin III and factor V mutation. The predominant presenting symptom was hematemesis (15 patients, 53.6%). Seven patients (25%) had splenomegaly. Three patients (10....

Journal of Pharmaceutical Research International

Introduction: Numerous obesity indices have been developed that predict non-alcoholic fatty liver... more Introduction: Numerous obesity indices have been developed that predict non-alcoholic fatty liver disease (NAFLD). We in our study aimed at evaluating a few of these tools including waist to height ratio (WHtR), waist circumferences (WC), body mass index (BMI) and fatty liver index (FLI) and used them to determine their ability in diagnosing NAFLD. Methods: This cross sectional study was conducted at the outpatients’ department of our hospital. NAFLD was diagnosed on the basis of ultrasound abdomen. Anthropometric parameters like Height (in), weight(cm), WC (cm), BMI, WHtR were calculated and later the FLI (comprising of BMI,WC, triglyceride and gamma glutamyl transferase) was calculated. The Receiver operating characteristic analysis (ROC) was then conducted to determine the discriminatory ability and related cut-off points and a P value of ≤0.05 was taken as statiscally significant. Results: A total of 300 participants were included and the prevalence of NAFLD was 44.8% in men and...

Supplemental material, sj-docx-1-tdo-10.1177_00494755211049031 for Intestinal Spirochaetosis-A ca... more Supplemental material, sj-docx-1-tdo-10.1177_00494755211049031 for Intestinal Spirochaetosis-A case series from the developing world by Zain Majid, Ghazi Abrar, Hina Ismail, Muhammad Danish, Muhammad Mubarak and Nasir Luck in Tropical Doctor

Supplemental material, sj-docx-2-tdo-10.1177_00494755211049031 for Intestinal Spirochaetosis-A ca... more Supplemental material, sj-docx-2-tdo-10.1177_00494755211049031 for Intestinal Spirochaetosis-A case series from the developing world by Zain Majid, Ghazi Abrar, Hina Ismail, Muhammad Danish, Muhammad Mubarak and Nasir Luck in Tropical Doctor

American Journal of Gastroenterology, 2021

Introduction: Endoscopic Ultrasound Elastography (EUS-EG), has emerged as a useful modality in es... more Introduction: Endoscopic Ultrasound Elastography (EUS-EG), has emerged as a useful modality in estimating tissue stiffness. Second generation techniques for elastography assessment allow quantitative measurements of average elasticity of a lesion. The strain ratio (SR) elastography is a semiquantitative measure of elastography patterns. This ratio is calculated by comparing the elastography patterns of the targeted lymph nodes (LN) to those of a nearby reference tissue. With help of this study we can improve diagnostic accuracy of EUS-EG in evaluation of malignant LN. The objective of this study is to assess the specificity, sensitivity and predictive values of the stain ratio (SR) measured by EUS-EG in differentiating benign from malignant lymph nodes (LNs). Methods: This prospective study included 106 patients with Abdominal/Mediastinal lymphadenopathy. Second generation EUS-EG was performed, in addition to detailed assessment of sonographic features of LN including: size, diameter, character, shape, echotexture (echogenic or echopoor) and hilum (lost or preserved). Strain ratio was calculated by EUS-EG ((Pentax EG-3830UT Echo-endoscope, HOYA Corporation, PENTAX Lifecare Division, Hitachi EUB-7000 ). Strain Ratio cut off was calculated on basis of receiver operating characteristic (ROC) curve analysis. Results: Majority of study population were males: 64 (60.4%).Mean age of 46.3 6 15.5 years. Mean size of lymph nodes was 22.2 6 7.7 mm and mean strain ratio was 61.9 6 46.3. In total 36 (34 %) patients had malignant lymphadenopathy on histopathology in which 88.8% were found to be hard on elastography. At cut off 27, strain ratio demonstrated sensitivity, specificity, positive and negative predictive values of 80.5 %, 58.7 %, 85.2% and 66.04%, respectively with area under the ROC (AUROC) of 0.72.On multivariate analysis, higher strain ratio (p50.002) and lymph node size 20mm(p5,0.001)werefoundtobesignificantlyassociatedwithpresenceofmalignantdisease.Conclusion:Althoughhistologyremainsthegoldstandardfordiagnosis,EUS−EGstrainratioisausefultechniquetopredictmalignancyinrestrainedsettingswherebiopsyisnotpossiblewhichincludes;vascularproximityand/chancesofseedling.Moreover,Strainratiocanalsobeutilizedindiseasestaging.Wedemonstratedthatlymphnodesize20 mm (p5, 0.001) were found to be significantly associated with presence of malignant disease. Conclusion: Although histology remains the gold standard for diagnosis, EUS-EG strain ratio is a useful technique to predict malignancy in restrained settings where biopsy is not possible which includes; vascular proximity and/ chances of seedling. Moreover, Strain ratio can also be utilized in disease staging. We demonstrated that lymph node size 20mm(p5,0.001)werefoundtobesignificantlyassociatedwithpresenceofmalignantdisease.Conclusion:Althoughhistologyremainsthegoldstandardfordiagnosis,EUS−EGstrainratioisausefultechniquetopredictmalignancyinrestrainedsettingswherebiopsyisnotpossiblewhichincludes;vascularproximityand/chancesofseedling.Moreover,Strainratiocanalsobeutilizedindiseasestaging.Wedemonstratedthatlymphnodesize 20 mm and EUS-EG strain ratio $ 27.1, has higher likelihood of malignancy.

American Journal of Gastroenterology, 2021

American Journal of Gastroenterology, 2021

Hina Ismail, MBBS1, Raja Taha Yaseen, MBBS2, Syed Mudassir Laeeq, MBBS, FCPS (Med)2, Farina Hanif... more Hina Ismail, MBBS1, Raja Taha Yaseen, MBBS2, Syed Mudassir Laeeq, MBBS, FCPS (Med)2, Farina Hanif, MBBS, FCPS1, Zain Majid, MBBS, FCPS (Gastro)2, Muhammad Adeel Farooq, MBBS2, Abbas Ali Tasneem, MBBS, FCPS (Med), FCPS (Gastro)2, Nasir Luck, MBBS, FCPS (Med), FCPS (Gastro)2, Kiran Bajaj, MBBS, FCPS2. Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan; Sindh institute of Urology and Transplantation, Karachi, Sindh, Pakistan.

American Journal of Gastroenterology, 2021

American Journal of Gastroenterology, 2020

Journal of Preventive Epidemiology, 2021

Human immunodeficiency virus (HIV) is an infectious disease that is rarely seen in ulcerative col... more Human immunodeficiency virus (HIV) is an infectious disease that is rarely seen in ulcerative colitis patients. Both diseases commonly involve the colon. It has been shown that treating these patients with anti-tumor necrosis factor (anti-TNF) therapy leads to remission of both conditions. We hereby present the case of a 7-year-old boy who was initially managed as a case ulcerative colitis after undergoing extensive workup and later on tested positive for HIV infection and was managed via mesalamine and highly active antiretroviral therapy (HAART). Mesalamine therapy along with HAART can be used to treat ulcerative colitis patients infected with HIV infection in resource limited countries.

American Journal of Gastroenterology, 2020

American Journal of Gastroenterology, 2017

American Journal of Gastroenterology, 2018

97 HBV+ were followed at Liver Associates of Texas Hepatology clinics and started on TAF treatmen... more 97 HBV+ were followed at Liver Associates of Texas Hepatology clinics and started on TAF treatment and followed. Lab values were taken before initiation of TAF therapy and then during 3, 6, and 9-month follow-up visits. Patients' baseline labs before starting the TAF medication served as their own control. Clinical variables considered included creatinine, eGFR (an estimate of creatinine clearance), transaminases, phosphorous, and magnesium levels. A paired-two sample mean t-test was performed on each of these variables with a significance level of 0.05. Results: 97 patients previously diagnosed with chronic HBV were studied; 67% were previously being treated with TDF, 10% previously with entecavir (ETV), 1% with adefovir dipivoxil, 6% were treatment naïve, 4% had an unknown previous treatment, and 11% with a combination of these antivirals. 62 (64%) were male, mean age 51±13, BMI: 24±4.6, 51% Asians, 19% African Americans, 4% Caucasians, 2% Hispanics, 23% other ethnicity. No significant difference was found between the creatinine, eGFR, AST, LFT, phosphorus, or magnesium levels of patients before or after treatment with TAF at either the 3-month, 6-month, and 9-month follow-up appointments. Conclusion: The results of this study supports those of previous studies that renal and liver functions are preserved in the short term when patients are treated with TAF. No significant differences were identified in the creatinine, GFR, ALT, AST, phosphorus, or magnesium levels of patients before or after treatment with TAF for 3, 6, or 9 months. This study reinforces a favorable safety profile in our HBV patients during this time period. Thus TAF has minimal or no renal and other organ toxicities in the short term.

American Journal of Gastroenterology, 2018

Journal of translational internal medicine, 2018

Gastrointestinal symptoms are common in patients with end stage renal disease (ESRD) among which ... more Gastrointestinal symptoms are common in patients with end stage renal disease (ESRD) among which dyspepsia is frequently observed. The aim of the study was to determine the frequency and associations of dyspepsia in ESRD patients using the Leeds questionnaire. All ESRD patients on maintenance hemodialysis were consecutively enrolled in the study. Leeds questionnaire was used to interrogate the patients for the assessment of dyspepsia. Mean and standard deviation were calculated for age, body mass index (BMI), disease duration and number of hemodialysis sessions. Independent t-test and Chi square tests were used for statistical analysis. Total number of patients was 200, out which 118 (59.3%) were male. The mean age was of 41.4 years. According to the Leeds questionnaire, dyspepsia was present in 62 (63.9%) patients. Younger patients (age 20-40 years) more frequently had dyspeptic symptoms (61.5% patients), retrosternal pain (156 patients, 78.0%), regurgitation (127 patients, 63.5%),...

Tropical Doctor, 2021

Spirochaetes comprise a heterogenous group of gram negative, motile, spiral shaped bacteria. Some... more 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.

American Journal of Gastroenterology, 2021

Introduction: Appropriate bowel preparation is cornerstone for detection of pathology during colo... more Introduction: Appropriate bowel preparation is cornerstone for detection of pathology during colonoscopy. The ideal preparation should not only ensure proper visualization of colonic mucosa but also should be tolerable and in-expensive. Both oral sodium phosphate containing and polyethylene glycol-based lavage are used predominantly as bowel cleansing modalities. Hence, we aim to assess the efficacy and tolerability of the two bowel preparation regimens for colonoscopy. Methods: Patients were randomized into two groups, Group 1; polyethylene glycol (PEG) (236 gm in two liter water in two divided doses) and Group 2 received sodium phosphate (NaP) (90 ml in two divided doses). Endoscopist was blinded to the type of preparation. Efficacy was measured by using Boston Bowel Preparation Scale (BBPS) scale. BBPS score more than 6 was labelled as optimum preparation. Tolerability was assessed by symptoms; nausea, abdominal pain, vomiting and abnormal taste. Results: In total 102 patients ; 58 (56.9%) were males . The mean age was 44.596 13.9 years and mean weight was 57.63 6 12.6 kg. NaP preparation was used in 53 (52%) while PEG based preparation in 49 (48%) patients, respectively. Median BBPs score was 7. Majority of study population (72.5%) had optimum preparation. In comparison to NaP preparation, patients with PEG based coloprep had BBPS score of $ 6 (P 5 0.02). Patient became nauseated (P 5 0.05) and developed altered taste (P # 0.001) with NaP preparation. While solution tolerability was better with PEG based preparation. (P # 0.001). Conclusion: Colonoscopy preparation is more efficacious and well tolerable with polyethylene glycol-based lavage as compared to sodium phosphate containing solution.

Journal of Preventive Epidemiology, 2021

Lymphomas are rarely associated with liver disease. We hereby present a case of anaplastic T cell... more Lymphomas are rarely associated with liver disease. We hereby present a case of anaplastic T cell lymphoma in a 45-year-old female, who had received four cycles CHOP chemotherapy regimen and was evaluated for abdominal pain, fever along with weight loss. She was later found to have features of chronic liver disease on ultrasound along with varices on screening endoscopy. Serological workup was positive for hepatitis C infection while her liver biopsy showed features of autoimmune hepatitis. She was managed with steroids and azathioprine along with direct acting antiviral agents.

Immunopathologia Persa, 2017

A middle aged male presented with abdominal distension since one month. Further workup showed pla... more A middle aged male presented with abdominal distension since one month. Further workup showed plasma hemoglobin of 18.1 g/dL with a high pack cell volume (PCV), raised urea, creatinine and disturbed liver function tests. Abdominal ultrasonography showed an enlarged caudate lobe with thrombi in the inferior vena cava while CT scan of abdomen confirmed the same findings and was suggestive of Budd-Chiari syndrome. Further workup was conducted to rule out other causes and to find out the possible cause of Budd-Chiari syndrome. A peripheral film was requested, which showed hyper-segmented neutrophils. Later on JAK2 mutation and thrombophilia profile was ordered, which was positive for JAK2 mutation. Even though the patient was started on low molecular weight heparin but he eventually passed away.