Waseem Raja - Academia.edu (original) (raw)

Papers by Waseem Raja

Portal Vein Thrombosis (PVT) is a common clinical problem often found in Gastroenterology Clinics... more Portal Vein Thrombosis (PVT) is a common clinical problem often found in Gastroenterology Clinics. It may occur with or without a pre-existing chronic liver disease. Clinical course may be acute or chronic. Clinical features vary in acute and chronic Portal Vein Thrombosis. Acute PVT usually presents with pain abdomen while as chronic PVT presents with features of Portal Hypertension. Management also differs-acute PVT is managed with anticoagulants while as chronic PVT is managed as portal hypertension.

A 75 year old female was admitted with dysphagia and dyspnea that was gradual in onset and progre... more A 75 year old female was admitted with dysphagia and dyspnea that was gradual in onset and progressive in nature. Patient had a history of toxic multinodular goiter and was currently on carbimazole. Examination revealed a hugely enlarged thyroid gland that was firm to hard in consistency. X-ray neck revealed revealed a calcified thyroid gland that looked like an Ostrich Eggshell. Thyroid profile was suggestive of drug induced hypothyroidism. Patient is planned for thyroidectomy to relieve her of obstructive symptoms after her thyroid functions return to normal. In addition she will receive thyroxine supplementation that will continue lifelong. Eggshell calcifications are common in goiter but the one reported by us has not been previously reported. Copyright: © 2015 Dar WR. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Upper GI bleed is a common, scary and life threatening medical condition usually caused by peptic... more Upper GI bleed is a common, scary and life threatening medical condition usually caused by peptic ulcer disease or oesophageal varices. Uncommon causes include neoplasms, aortoenteric fistulas, vascular lesions, Dieulafoy's lesion etc. Patients usually present with hematemesis or melena. GIST is the third most common tumor of stomach and also the most common mesenchymal tumor. GIST may be asymptomatic and discovered incidentally or they may cause nonspecific symptoms like early satiety and fullness. Although major presentation of GIST is upper GI bleed, GIST as a cause of upper GI bleed is very rare. We here present a patient admitted to us with massive upper GI bleed due to gastrointestinal stromal tumor. Citation: Dar WJ, Sofi N, Dar IA, Kasana BA, Hussain M, Latief M (2015). A rare cause of upper GI bleed. World Journal of Internal Medicine, 2(1): 003-006.

D iabetic myonecrosis, an overlooked complication of longstanding diabetes mellitus, was first de... more D iabetic myonecrosis, an overlooked complication of longstanding diabetes mellitus, was first described by Angerwall and Stener in 1965. 1 It usually affects quadriceps muscles but other muscle groups may be involved rarely. Painful swelling of the affected muscle group without systemic manifestations is the usual presentation. Women are more frequently affected than men and most of the affected patients already have other microvascular complications of diabetes. A hyperintense signal on T2-weighted images in the presence of classical clinical findings provides sufficient evidence for diagnosis. Short term prognosis is good and most patients recover spontaneously with bed rest, adequate analgesia, and good glycemic control.

Background: Hepatitis B virus (HBV) infection is increased in cancer patients and those receiving... more Background: Hepatitis B virus (HBV) infection is increased in cancer patients and those receiving chemotherapy are at risk of HBV reactivation with high mortality. Screening for occult and overt HBV infection is not widely practiced in cancer patients. Objectives: To assess the prevalence of occult and overt HBV infection in cancer patients at initial diagnosis prior to receiving chemotherapy(CT). Methods: At initial diagnosis of cancer, patients were examined for any evidence of liver disease followed by screening for serum markers of HBV infection (HBsAg, total anti HB core, anti HBs antibody and HBV DNA). Results: Isolated anti HBsAg positivity and previous resolved HBV infection was seen in 98(14.2%) and 88/690 (12.7%) patients respectively. HBV infection was seen in 68/690(9.8%) patients which included overt and occult HBV infection in 55/690 (8%) and 13/690 (1.9%) respectively. Overt and occult HBV infection in hematological cancers was more as compared to solid cancers [16/140(11.4%) vs 39/550 (7%), p=0.09] and 5/140(3.6) vs 8/550(1.4) p=<0.15] respectively. There was no significant difference in HBsAg positivity based on sex [31/393(7.8%) men vs 24/297(8%) women, p=0.9)], age [7/74(9.4 %) < 20yrs, 39/490 (7.9 %), 21-60 yrs, 9/126 (7.1%) > 60yrs), p=0.84], previous blood transfusions (BT) [13/170 (7.6%) BT vs 42/520 (8.0%), no BT, p=0.9)], history of jaundice [7/88 (8%) vs 35/602 (5. 8%, p=0.8)] or ALT values, [42/545(7.7%) vs 13/145(7%), p=0.8)]. Conclusion: HBV infection is increased in cancer patients. Patients should be screened for both occult and overt HBV infection by testing serum HBsAg, HBV DNA and anti HB core antibody.

Acute Hepatitis A is very common in children, particularly in developing countries. Patients may ... more Acute Hepatitis A is very common in children, particularly in developing countries. Patients may be asymptomatic or present with acute hepatitis. Rare presentations include cholestatic, with jaundice lasting 10 weeks or more, relapsing, with two or more bouts of acute HAV infection occurring over a 6-to 10-week period, and fulminant hepatic failure. Gall bladder abnormalities are fairly common in hepatitis A infection but cholecystitis is extremely rare. Although Acalculous cholecystitis carries a bad prognosis, hepatitis A associated cholecystitis resolves spontaneously and carries excellent prognosis. We here present a case of Hepatitis A associated Acalculous cholecystitis. A review of literature follows.

Introduction: Lower gastrointestinal bleeding (LGIB) is one of the leading causes for hospital ad... more Introduction: Lower gastrointestinal bleeding (LGIB) is one of the leading causes for hospital admissions in gastroenterology wards all over the world. Patients usually present with hematochezia or bloody diarrhea. Colonoscopy is usually the initial diagnostic intervention followed by other more sophisticated tests. Bleeding may stop spontaneously, but evaluation is important because patients may harbor a sinister lesion like cancer. Aim of the Study: To determine the various etiologies, clinical presentations, a diagnostic test used and treatments received by LGIB patients admitted in our department. Materials and Methods: A total of 300 cases were studied which included 180 retrospective cases and 120 prospective cases. For retrospective cases, all the information was obtained by analyzing their case records while as prospective patients were managed as per a predefined protocol and details of various investigations and treatments documented. Results: Most commonly affected was elderly population (>60 years), constituting 40% (120/300) of studied population. Males constituted 59% (177/300) and females 41% (123/300). The most common clinical presentation of LGIB in our patients was hematochezia (63.6%, 191/300). Growth/polyp was the most common finding on colonoscopic examination seen in 29.3% (n = 88) patients. Inflammatory lesions were seen in 77 out of 239 (25.7%) patients. Wireless capsule endoscopy was positive in 13 out of 24 patients (54%). Computed tomography (CT) enterography showed positive results in 6 out of 25 (24%) cases. Red blood cell scan was done in seven patients while as CT angiography in in four patients. Therapeutic endoscopy was successful in 115 out of 239 patients with positive colonoscopy, polypectomy was the commonest procedure performed. Medical management was carried out in 34.6% patients. Surgical treatment was offered to 21% patients. Conclusion: Colonoscopy is the initial and most common investigation used in the evaluation of GI bleed. A polyp is the most common diagnosis while as polypectomy the most common therapeutic procedure.