Euroasian journal of hepato-gastroenterology

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2023 | July-December | Volume 13 | Issue 2

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Original Article

Dilip Kumar Ghosh, Debashis Kumar Sarkar, Mukta Nath, Parash Ullah, Mohammad Faiz Ahmad Khondaker, Shamsuddin Al Masud Chowdhury, Mohammad Mahmuduzzaman

Symptoms and Prevalence of Constipation among Adult Population of Bangladesh

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:45 - 49]

Keywords: Bangladesh, Bristol's criteria, Constipation, Prevalence, Rome III criteria, Self-reported perception

   DOI: 10.5005/jp-journals-10018-1393  |  Open Access |  How to cite  | 


Background: Constipation is one of the most common gastrointestinal disorders. The prevalence of constipation is rapidly increasing globally. It has adverse effects on the patient's quality of life including productivity and results in a high financial hardship on the healthcare system. The aim of the study was to estimate the symptoms and prevalence of constipation among the adult population of Bangladesh. Materials and methods: It was a cross-sectional observational study based on a structured questionnaire and a checklist. In this study, three criteria were used for the diagnosis of chronic constipation (self-reported perception, Rome III criteria, and Bristol's criteria). The study was conducted among 1,550 population between July 2019 and December 2019. Result: The study population consisted of 1,550 respondents, among them 41.61% male and 58.39% female, and the mean age was 32.71 ± 9.72 years. In the study, 12.2% of the population was categorized to have constipation according to self-reported perception, 11.2% according to Rome III, and 10.3% reported to have been suffering from constipation according to Bristol chart. Female gender tends to have a greater prevalence than male. In multivariate analysis for constipation, betel nut chewer, alcohol consumer, diabetes mellitus, hypertension, GI surgery, and bronchial asthma were significantly (p < 0.001) associated with constipation. According to Bristol's criteria, the most common stool form was Type III (sausage-shaped with cracked surface) among the Bangladeshi population in this study. Conclusion: Chronic constipation is a common problem worldwide. The findings of this study suggest that there is a high prevalence of constipation among the general population of Bangladesh. Decreasing modifiable risk factors of constipation can reduce its prevalence and burden of the disease. Bangladesh is markedly deficient in literature citing constipation prevalence and determinants. These findings may commence a call for setting priority as one of the major public health problems and demanding attention for both at the clinical and community levels.


Original Article

Loganathan Jayapal, Santhosh R Kumar, Gilbert Samuel Jebakumar, Siddesh S Tasgaonkar, Sudeepta Kumar Swain, Venkatesh Munikrishnan, Tirupporur Govindaswamy Balachandar

Solid Pseudopapillary Neoplasm of the Pancreas: Unraveling Insights from a Single Institutional Study Emphasizing Preoperative Diagnosis of a Rare Tumor

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:50 - 54]

Keywords: Diagnosis, Endoscopic ultrasound, Fine needle aspiration cytology (FNAC), Immunohistochemistry, Retrospective, Solid pseudopapillary neoplasm

   DOI: 10.5005/jp-journals-10018-1394  |  Open Access |  How to cite  | 


Aim: Solid pseudopapillary neoplasm (SPN), a slow-growing pancreatic tumor with a vague clinical presentation and non-specific radiological features, is rather uncommon. We share our experience emphasizing on preoperative diagnosis and the correlation with final histopathological examination. Materials and methods: This is a retrospective analysis of the 468 patients who underwent pancreas-related surgery at our institution between January 2013 and July 2022. Demographic characteristics, symptoms at presentation, preoperative serum calcium carbohydrate antigen (CA 19-9), lesion characteristics on cross-sectional diagnostic imaging, surgical technique, complications in postoperative period, length of stay, histopathological features, and 3-year follow-up findings of the patients with SPN of pancreas were evaluated. Results: The male-to-female ratio was 1:11 and the mean age at presentation was 33.3 ± 9.5 years. Upper abdomen discomfort was the most common presenting complaint (91%). And five patients had findings suggestive of SPN on preoperative CECT abdomen, and the remaining six individuals were diagnosed solely based on final histological examination. The tumor's median diameter was 5.6 cm (range, 4.1–7.9). The distal body and tail of pancreas was the most common location (63%), followed by the head (36%), and was managed with distal pancreatectomy with or without spleen preservation and Whipple's procedure, respectively. One patient developed grade III Clavien-Dindo complication. The average length of in-hospital stay was 8.27±2.72 days. None of the patients had recurrence on follow-up. Conclusion: Solid pseudopapillary neoplasm of the pancreas is often misdiagnosed preoperatively. Endoscopic ultrasound-guided FNA with IHC will be beneficial to diagnose it preoperatively especially in small-sized tumors with atypical features. Complete surgical resection with adequate margins without routine lymphadenectomy is curative in resectable tumors.


Original Article

Rajendiran Ramalingam, Kuppusamy Senthamizhselvan, KT Harichandrakumar, Pazhanivel Mohan

Effect of Premedication with Glycopyrrolate on Patient Tolerance and Procedure Outcomes in Patients Undergoing Unsedated Upper Gastrointestinal Endoscopy: A Randomized Placebo-controlled Trial

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:6] [Pages No:55 - 60]

Keywords: Endoscopy, Gastrointestinal, Glycopyrrolate, Premedication, Patient satisfaction

   DOI: 10.5005/jp-journals-10018-1395  |  Open Access |  How to cite  | 


Background and aim: An optimal topical pharyngeal anesthesia (TPA) is required for better patient tolerance and procedural outcomes of an unsedated upper gastrointestinal endoscopy (UGIE). Several additional strategies have been tried to improve patient tolerance with limited success. We hypothesized that premedication with glycopyrrolate would enhance TPA and improve patient tolerance and procedural outcomes of an unsedated UGIE. Materials and methods: We conducted a randomized, double-blind, placebo-controlled trial between July 2020 and May 2022. Consecutive patients undergoing unsedated UGIE were randomly assigned to receive either intravenous glycopyrrolate or a placebo 30 minutes before TPA. Patient tolerance, comfort level for the endoscopist, cardiorespiratory fluctuations, percentage of failed esophageal intubation, and incomplete examination were studied. Results: 380 patients were randomized to 190 in each arm. The median (IQR) VAS scores for the overall patient satisfaction in the glycopyrrolate and placebo groups were 8 (1) and 7 (2), respectively (p = 0.04). The median (IQR) VAS scores for endoscopist assessment of patient cooperation in the glycopyrrolate and placebo groups were 8 (1.3) and 8 (1), respectively (p = 0.04). There was no difference in the percentage of failed esophageal intubation and incomplete examination, fluctuations in heart rate, and oxygen saturation of the participants. However, the mean arterial pressure (MAP) on-table before the start of the procedure at 1 minute and 3 minutes was significantly higher in the glycopyrrolate group (p = 0.01, 0.01, and 0.04, respectively). Conclusion: In unsedated UGIE, glycopyrrolate premedication significantly improves the patient tolerance and endoscopist's comfort, with minimal cardiorespiratory effects. Hence, it could be incorporated into day-care unsedated endoscopy practice. Trial registration – CTRI/2020/07/026786.


Original Article

Santhosh Kumar Ramesh, Sudeepta Kumar Swain, Venkatesh Munikrishnan, Jainudeen Khalander Abdul Jameel

Can the Inflammatory Cell Ratio NLR and PLR be Used as a Reliable Marker in Colon Cancer? A Prospective Study

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:61 - 65]

Keywords: Colorectal cancer, Gastrointestinal malignancies, Neutrophil–leukocyte ratio, Platelet–lymphocyte ratio, Serum biomarkers

   DOI: 10.5005/jp-journals-10018-1399  |  Open Access | 


Background: Simple approaches for detecting the tumor stage of colon cancer patients are required during the preoperative period. In recent years, the neutrophil-lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) have been employed as predictive parameters for systemic inflammatory response and long-term prognosis in a variety of malignancies. The purpose of this study was to determine whether the NLR and PLR correspond with tumor characteristics in colon cancer patients. Materials and methods: About 90 patients with colon cancer who reported to our institute during the time interval July 2021 to December 2022 were included in the study. The NLR and PLR were calculated using data obtained from a complete blood count evaluation. The relationship between inflammatory cell ratio and tumor-specific characteristics were analyzed. Results: Neutrophil–lymphocyte ratio and PLR correlated with pTNM staging in 88 patients. Two patients exhibited diffuse peritoneal metastasis. A significant association was found between PLR and early (Tis + T1 + T2) and advanced (T3 + T4) groups. Although the difference was not statistically significant, patients with lymphovascular invasion (LVI) and perineural invasion (PNI) had greater mean NLR and PLR. Conclusion: Platelet–lymphocyte ratio was found to be more accurate than NLR in predicting colon cancer tumor depth/invasion. A high PLR value aids in prognosticating advanced T-stage colon cancer patients and can be used as a valuable tool for preoperative counseling, but it must be validated with a survival analysis. Clinical practice points: The tumor microenvironment contains a variety of inflammatory cells that contribute to the growth and spread of the neoplasm. The NLR and PLR have been shown to be clinically and prognostically important in a variety of gastrointestinal cancers. The results of this study demonstrate that PLR was more accurate than NLR in predicting colon cancer tumor depth/invasion. Also, a high PLR value aids in prognosticating advanced T-stage colon cancer patients and may be used as a valuable tool for preoperative counseling.


Original Article

Kiran Arshad, Sheikh Danial Hanan, Muhammad Numair Younis, Rimsha Badar, Minahil Imran, Nefal Numair, Abubakar Imran

Detection of Primary Hepatocellular Carcinoma on18F-Fluorodeoxyglucose Positron Emission Tomography-computed Tomography

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:7] [Pages No:66 - 72]

Keywords: Computed tomography, Hepatocellular carcinoma, 18F-flourodeoxyglucose positron emission tomography-computed tomography, Sensitivity

   DOI: 10.5005/jp-journals-10018-1409  |  Open Access |  How to cite  | 


Aims and background: Hepatocellular carcinoma (HCC), ranks as the third most prevalent malignancy contributing to cancer-related death on a global scale. Hepatocellular carcinoma is known to be the fifth most frequently diagnosed malignancy of the males while among females, it is ranked as the seventh most common malignancy. The study was conducted to detect the sensitivity of primary HCC using18F-flourodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) scan. Materials and methods: This prospective study was conducted to identify the primary HCC in a sample size of 51 patients, in whom FDG PET-CT scan was performed between May 2022 and December 2022. Results: Among the cohort of 51 patients, primary HCC was detected on FDG PET-CT in 43 individuals representing true-positive cases. Conversely, FDG PET-CT was unable to detect HCC in 8 cases, representing false-negative. Out of 51 patients, 74.5% of HCC cases exhibited multifocal pattern. The maximum standardized uptake value (SUV max) of the primary malignant site ranged from 1.9 to 16.1, with a mean of 3.7 ± 2.8. The FDG PET-CT revealed abnormal sites of the uptake outside liver in 23 individuals. The research confirmed the tumor recurrence in four previously treated patients. In the conducted investigation, FDG PET-CT showed 84.3% sensitivity for the diagnosis of HCC. Conclusion: The study demonstrates that FDG PET-CT is a viable option for the detection of HCC. The sensitivity of FDG PET-CT in our population is comparable and in agreement with international data for diagnosis of HCC thereby favoring its reproducibility among geographical and ethnic groups. However, owing to the reduced ability of FDG PET-CT scan to identify well-differentiated/low-grade HCC, the routine use of FDG PET-CT scan may not be considered in cases requiring evaluation of primary disease only.


Original Article

Freya Milagros Freyre, Jorge A Aguiar, Zurina Cinza, Nelvis Figueroa, Pablo Arsenio Diaz, Verena Lucila Muzio, Gilda Lemos, Giselle Freyre, Edelgis Coizeau, Chabeli Rodríguez, Eduardo Penton, Magalys Campos, Iván Luis Santos, Mamun Al Mahtab, Sheikh Mohammad Fazle Akbar, Gerardo E Guillén, Julio Cesar Aguilar

Impact of the Route and Schedule of Immunization on the Serological and Virological Response of Chronic Hepatitis B Patients Treated with HeberNasvac

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:6] [Pages No:73 - 78]

Keywords: Chronic hepatitis B, HeberNasvac, Hepatitis B Virus, Hepatitis B surface antigen, Therapeutic vaccines

   DOI: 10.5005/jp-journals-10018-1402  |  Open Access |  How to cite  | 


HeberNasvac is a recently developed therapeutic vaccine for chronic hepatitis B (CHB) administered by intranasal (IN) and subcutaneous (SC) routes in a 14 days/10 doses schedule. To compare different schedules and routes of immunizations, a group of patients received four different vaccination regimens in a placebo-controlled factorial study. Subsequently, patients were followed for a minimum time of 48 weeks. Samples collected at the end of the follow-up were compared with initial samples. Groups I and II received the product by IN/SC routes, every 14 and 7 days, respectively. Groups III and IV were treated by SC route alone following a 14 and 7 days schedule. A group of 21 CHB patients received the vaccine in four different schedules and eight patients received placebo for a total of 29 patients enrolled. The 61.9% of vaccinees reduced their VL ≥2Log compared with baseline levels and 25% in placebo group. The 47.6% of vaccines reduced HBV levels to undetectable, 25% in placebo. HBeAg loss and seroconversion to anti-HBeAg was only achieved in vaccinees, 4 out of 9 (44.4%), and 40% (8 out of 20) developed anti-HBs response, none in placebo group. Reduction of HBsAg level in ≥1Log was achieved in the 35.0% of vaccinees and in none of the placebo-treated patients. Considering the individual and factorial analysis, significant HBV DNA reduction was detected in groups I and II, immunized by IN/SC routes. A significantly higher proportion of patients reducing VL to ≥2Log was also detected grouping the patients treated by IN/SC routes (G I + II) and grouping those inoculated every 14 days (G I + III), with 72.7% and 63.6%, respectively, compared with the placebo group (25.0%). The patients immunized every 14 days (G I + G III) also reduced the HBsAg levels compared with baseline. In conclusion, after more than 48 weeks of treatment-free follow-up, HeberNasvac-treated patients demonstrated superior responses compared with the placebo group in terms of antiviral and serological responses. The factorial analysis evidenced that the schedule combining the IN route of immunization and the frequency of 14 days resulted in the stronger antiviral and serological responses. Present results support the study of IN-only immunization schedules in future and was consistent with previous results. Long-lasting follow-ups were done to explore histological variables and the progression of serological variables in order to detect late responders.


Original Article

Merina Rahman, Sheikh Mohammad Noor-E-Alam, Md Abdur Rahim, Dulal Chandra Das, Faysal Ahmed, Ayub Al Mamun, Tasnim Mahmud, Tarim Mahmood

Depression among Patients with Chronic Hepatitis B: A Cross-sectional Study in a Tertiary Hospital of Bangladesh

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:79 - 83]

Keywords: Depression, Hepatitis B, Mental health, Patient

   DOI: 10.5005/jp-journals-10018-1406  |  Open Access |  How to cite  | 


Background: Patients with chronic hepatitis B suffer not only from physical illness. Rather, they often present with the mental health consequences of this chronic disease. Objective: The major objective was to assess the level of depression among patients having chronic hepatitis B. Method: The Department of Hepatology of Bangabandhu Sheikh Mujib Medical University directed this study which was a comparative cross-sectional study during time duration from September 2021 to September 2022. Incidence and grading of depression between patients with chronic hepatitis B and HBsAg negative healthy volunteers were assessed and compared through this study. The association of different variables with depression among chronic hepatitis B (CHB) patients was also measured. Results: Out of 90 patients having chronic hepatitis B, 52 (57.8%) were found to have some degree of depression; whereas among 90 HBsAg-negative healthy controls, 32 (35.6%) were found to have various degrees of depression. The dissimilarity between the two groups was significantly determined (p-value < 0.05). The majority of the depressed population from both groups had mild degrees of depression, however, the variance was not top the notch (p-value > 0.05). But the prevalence of moderate depression and moderately severe depression was statistically significant among CHB patients compared to their counterpart controls. Depression among CHB patients was found to be female-predominant. Conclusion: The study has shown a higher prevalence of depression among patients with chronic hepatitis B compared to HBsAg-negative healthy controls.


Original Article

Md Ashrafujjaman, Mamun Al Mahtab, Sheikh Mohammad Noor-E-Alam, Md Abdur Rahim, Dulal Chandra Das, Faysal Ahmed, Ayub Al Mamun, Tasnim Mahmud, Tarim Mahmood

Role of Biobran (Arabinoxylan Rice Bran) on Patients with Advanced Stage Hepatocellular Carcinoma

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:84 - 88]

Keywords: Biobran, Carcinoma of liver, Food supplement, Terminal stage

   DOI: 10.5005/jp-journals-10018-1407  |  Open Access |  How to cite  | 


Background and objectives: Carcinoma of liver – renowned, has taken third position in world ranking, comparing to other causes for cancer-related death, however, curative treatment of hepatocellular carcinoma (HCC) is largely absent and even proper management of HCC patients is extremely difficult. The situation becomes more complex when HCC patients are attended by physicians in their terminal state. Arabinoxylan rice bran (biobran) is an inherent product and hemicellulose which is denatured, as well as gained by hemicellulose including a number of hydrolyzing enzymes of carbohydrate from Shiitake mushrooms. It enhances activities of different immune cells and may exert some effects in cancer patients. Materials and methods: In this observation study, the implication of biobran was assessed in a small group of 52 HCC patients. One halves of the patient received biobran and the other halves received best supportive care (BSC). Results: Baseline parameters in two groups were mostly comparable. During observation after 30, 60, and 90 days, a total of six, one, and one patient were alive in biobran group, respectively. The survival of cancer patients of the BSC group was comparable at these time points (6, 1, and 0, respectively) with no statistical significance. After 30 days of treatment, those who were survived in biobran group, the mean CP score was 11.00 ± 1.55 and 10.50 ± 0.84 at pretreatment and posttreatment, respectively, (p = 0.20). Conclusion: Biobran may be of some benefit for terminal HCC, however, more studies are warranted to optimize dose and duration of therapy.


Original Article

Md Nur Islam, Md Enayet Ali Pramanik, Md Arju Hossain, Md Hasanur Rahman, Md Sahadot Hossen, Md Ashraful Islam, M Morsed Zaman Miah, Istiak Ahmed, AZM Mostaque Hossain, Md Jawadul Haque, AKM Monoarul Islam, Md Nowshad Ali, Rukhshana Akhter Jahan, Md Enamul Haque, Md Munzur Rahman, Md Sharif Hasan, Mohammad Motiur Rahman, Md Mamun Kabir, Prabir Mohan Basak, Md Abdul Mumit Sarkar, Md Shafiqul Islam, Md Rashedur Rahman, AKM Azad-ud-doula Prodhan, Ashik Mosaddik, Humayra Haque, Fahmida Fahmin, Haimanti Shukla Das, Md Manzurul Islam, Chandrima Emtia, Md Royhan Gofur

Identification of Leading Compounds from Euphorbia neriifolia (Dudsor) Extracts as a Potential Inhibitor of SARS-CoV-2 ACE2-RBDS1 Receptor Complex: An Insight from Molecular Docking ADMET Profiling and MD-simulation Studies

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:19] [Pages No:89 - 107]

Keywords: Absorption, distribution, metabolism, excretion, and toxicity (ADMET), Angiotensin converting enzyme 2, Coronavirus disease-19, Euphorbia neriifolia and phytochemicals, Molecular docking, Molecular dynamics simulation, Molecular mechanics of generalized born and surface

   DOI: 10.5005/jp-journals-10018-1414  |  Open Access |  How to cite  | 


Coronavirus disease-19 (COVID-19) are deadly and infectious disease that impacts individuals in a variety of ways. Scientists have stepped up their attempts to find an antiviral drug that targets the spike protein (S) of Angiotensin converting enzyme 2 (ACE2) (receptor protein) as a viable therapeutic target for coronavirus. The most recent study examines the potential antagonistic effects of 17 phytochemicals present in the plant extraction of Euphorbia neriifolia on the anti-SARS-CoV-2 ACE2 protein. Computational techniques like molecular docking, absorption, distribution, metabolism, excretion, and toxicity (ADMET) investigations, and molecular dynamics (MD) simulation analysis were used to investigate the actions of these phytochemicals. The results of molecular docking studies showed that the control ligand (2-acetamido-2-deoxy-β-D-glucopyranose) had a binding potential of –6.2 kcal/mol, but the binding potentials of delphin, β-amyrin, and tulipanin are greater at –10.4, 10.0, and –9.6 kcal/mol. To verify their drug-likeness, the discovered hits were put via Lipinski filters and ADMET analysis. According to MD simulations of the complex run for 100 numbers, delphin binds to the SARS-CoV-2 ACE2 receptor's active region with good stability. In root-mean-square deviation (RMSD) and root mean square fluctuation (RMSF) calculations, delphinan, β-amyrin, and tulipanin showed reduced variance with the receptor binding domain subunit 1(RBD S1) ACE2 protein complex. The solvent accessible surface area (SASA), radius of gyration (Rg), molecular surface area (MolSA), and polar surface area (PSA) validation results for these three compounds were likewise encouraging. The convenient binding energies across the 100 numbers binding period were discovered by using molecular mechanics of generalized born and surface (MM/GBSA) to estimate the ligand-binding free energies to the protein receptor. All things considered, the information points to a greater likelihood of chemicals found in Euphorbia neriifolia binding to the SARS-CoV-2 ACE2 active site. To determine these lead compounds’ anti-SARS-CoV-2 potential, in vitro and in vivo studies should be conducted.


Original Article

Jasmine Samal, Tushar Prabhakar, Manya Prasad, Nitiksha Rani, Bansidhar Tarai, Reshu Agarwal, Abhishek Padhi, Arvind Tomar, Rakhi Maiwall, Debajyoti Bhattacharyya, Manoj Kumar Sharma, Ekta Gupta

Prevalence and Predictors for Respiratory Viral Infections among Liver Disease Patients

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:7] [Pages No:108 - 114]

Keywords: Cirrhosis, Gender, Influenza, Liver, Noninfluenza, Respiratory viral infection, Seasonality

   DOI: 10.5005/jp-journals-10018-1400  |  Open Access |  How to cite  | 


Aim and background: Respiratory viral infections (RVIs) cause significant hospitalizations every year. Also, RVIs caused by either influenza or noninfluenza group of viruses can have adverse outcomes, especially among immunosuppressed patients. Regular and timely supervision is needed for accurate etiological identification, to prevent inappropriate use of antibiotics in patients with nonbacterial etiology. This study aimed to identify the spectrum of RVIs and clinical characteristics among liver disease patients with influenza-like illness (ILI). Materials and methods: In this study, medical records of patients with ILI, whose requests for respiratory viral testing came from September 2016 to December 2022 were retrospectively reviewed. Respiratory viruses were identified using FilmArray 2.0 respiratory panel (BioFire Diagnostics, USA). Results: Of the 1,577 liver disease patients with ILI, the overall prevalence of RVI was 28% (n = 449). Infection by noninfluenza viruses (NIVs) was detected in 329 patients (73%), higher than those infected with influenza viruses. In multivariable logistic regression analysis, female gender [odds ratio (OR): 2.5, 95% confidence interval (CI): 1.5–4.2], infection with influenza B (OR: 3.3, 95% CI: 1.09–9.9) and decompensated cirrhosis (OR: 3.9, 95% CI: 1.7–8.5) were independent risk factors for mortality. Regarding seasonality, influenza peaked in monsoons and winters, whereas NIVs circulated throughout the year. Conclusion: Overall, this study adds new knowledge regarding the incidence of RVI and the distribution of respiratory viral etiologies among liver disease patients with ILI. The findings highlight that female gender, decompensated cirrhosis, and influenza B infection are independently associated with poor clinical outcomes. Early etiological identification of viral causes of ILI could aid in an enhanced understanding of the prevalence of ILI and the timely management of the patients. Clinical significance: Respiratory viral infections can cause severe illness in individuals with underlying liver disease. Accurate diagnosis and risk stratification is crucial in mitigating the adverse health effects.


Original Article

Tabarak Qassim, Mirza Faraz Saeed, Aya Qassim, Sana Al-Rawi, Sabrina Al-Salmi, Mustafa Thaer Salman, Ibrahim Al-Saadi, Abdulaziz Almutawea, Eman Aljahmi, Mohamed Khalid Fadhul, Isam Mazin Juma

Intestinal Stomas—Current Practice and Challenges: An Institutional Review

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:115 - 119]

Keywords: Bleeding, Complications of stomas, Electrolyte imbalance, Fistulas, Infection, Parastomal hernias, Stomas

   DOI: 10.5005/jp-journals-10018-1404  |  Open Access |  How to cite  | 


Introduction: A stoma is an artificial anastomosis of the gastrointestinal tract to the abdominal skin wall to reroute the stream of feces. Fecal diversion, bowel decompression, and anastomosis protection are common indications for stomas. Relative to other surgical operations, stomas have a high morbidity rate, with rates averaging 40% and ranging 14–79%. The most common early complication was peristomal skin irritation. In contrast, parastomal hernias were the most common late complication. Methods: This research was performed at King Hamad University Hospital (KHUH) in the Kingdom of Bahrain. Our study included patients who had undergone ileostomies and colostomies. The inclusion criteria included adult patients who are 15 years and older, both emergency and elective cases, and with ASA score of 1–4. The excluded patients were those who had had their stomas performed outside of KHUH and those who were not following up in the hyperbaric department of our hospital. This study was performed using a retrospective study design. The sample size was 98 which included patients with stomas that were following up with the hyperbaric team between January 2018 and February 2021. Results: We have broken down the indications for stoma formation. The breakdown of all our documented complications are illustrated in the given figure. Conclusion: Within our institutional study, 63.3% of stoma complications consisted of skin problems. This formed the majority of complications. Establishing a stoma care unit would offer continuous support and care to patients and help them in returning to an optimal quality of life. Additionally, this goal can be met through preoperative and postoperative education regarding surgery and stoma formation. This includes preoperative stoma marking and siting, as well as improved recovery through instruction from knowledgeable stoma care specialists regarding hands-on stoma care. Finally, patients can be assisted through specialized stoma clinics.


Original Article

Kalpana Acharya, Vaishali Bhardwaj, Imran Chuahan, Syed Mushfiq, Sunil Bhatt, Brij Mohan Lamba

Comparison of Fecal Calprotectin with Different Endoscopic Scores in the Assessment of Ulcerative Colitis (UC) Activity and Its Utility in Differentiating IBS from IBD

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:4] [Pages No:120 - 123]

Keywords: Disease activity, Fecal calprotectin, Irritable bowel disease, Irritable bowel syndrome

   DOI: 10.5005/jp-journals-10018-1411  |  Open Access |  How to cite  | 


Background: Ulcerative colitis (UC), a chronic inflammatory disease of gastrointestinal tract, can have initial presentation which is clinically difficult to differentiate from functional bowel disorders [irritable bowel syndrome (IBS) and irritable bowel disease (IBD)]. Conventional laboratory tests, such as erythrocyte sedimentation rate (ESR), C-reactive protein, and albumin express systemic patient responses instead of intestinal inflammation. In the last decade, fecal calprotectin, a calcium-binding protein, has been suggested as a sensitive marker of intestinal inflammation. However, only few studies have investigated its role in relation with the extent of the disease. Aim: To evaluate the usefulness of fecal calprotectin as a biomarker for disease activity in UC, its correlation with disease extent and its utility in differentiating IBS from IBD. Methods: A total of 75 patients (50 cases with colonoscopic evidence of inflammation and 25 cases with normal colonoscopic examination) were included in the study. Fecal calprotectin test was done on the day of colonoscopy. Severity of the disease was assessed by modified Mayo's endoscopy score (MMES). Results: Age and baseline parameters were comparable in both the groups (UC and IBS). Patients in the ulcerative group had tachycardia (95 vs 74), high ESR (26 vs 20), high leukocytes count (9198 vs 8852), high fecal calprotectin (594 vs 29), low albumin (3.00 vs 3.80) and low hemoglobin (11 vs 13.40). Minimum and maximum MMES were 2 and 13.2. A significant correlation was observed between fecal calprotectin and MMES (p-value < 0.001). Conclusion: Fecal calprotectin is a simple, noninvasive, cost-effective marker that is strongly associated with colorectal inflammation; moreover, it has better role in the differentiation of IBD (UC) from IBS.


Original Article

Nazish Butt, Muhammad Masood, Aamir Ali

Efficacy and Safety of Prunus mume and Choline in Patients with Nonalcoholic Fatty Liver Disease

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:4] [Pages No:124 - 127]

Keywords: Choline, Fatty liver, Lipid profile, Liver enzymes, Nonalcoholic liver diseases, Prunus mume

   DOI: 10.5005/jp-journals-10018-1397  |  Open Access |  How to cite  | 


Aim: The primary objectives of this study include evaluating changes in lipid profile and liver enzyme levels in nonalcoholic fatty liver disease (NAFLD) patients receiving Prunus mume and choline supplementation (Revolic). Materials and methods: Two-hundred patients were recruited from the hepatology outpatient department of a public hospital between January and June 2023. Patients who had confirmed diagnosis of NAFLD, proven with ultrasound (US) followed by biopsy or US alone with age >18 years were included in this study. The study variables were fasting blood sugar, cholesterol levels, low-density lipoprotein (LDL), triglyceride, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase levels (GGT). All investigations were conducted and compared between baseline, 12 and 24 weeks following treatment. Results: The mean age of all participants was 40.49 ± 10.59 years with 34 males and 166 females. The mean cholesterol levels were reduced to 179.86 ± 35.63 mg/dL from the mean baseline of 197.57 ± 42.52 mg/dL (p = 0.001). There was also a statistically significant difference found between baseline and posttreatment levels of LDL and triglyceride (p < 0.001). The ATL levels were also reduced from baseline 44.91 ± 32.40 U/L to 44.25 ± 30.66 and 41.06 ± 22.15 U/L between 12 and 24 weeks after treatment respectively. There was a statistically significant reduction in ATL, AST, and GGT levels from baseline with p-value < 0.001. Conclusion: The combination of P. mume and choline (Revolic) gives promising results with a significant reduction in lipid profile and liver enzymes. Clinical significance: The combination of P. mume and choline can be considered a reliable option for the management of NAFLD due to its efficacy and safety at 24 weeks after treatment as evident in the present study.


Original Article

M Morsed Zaman Miah, Md Enayet Ali Pramanik, M Abdur Rafi, Mira Akhter

Reticulocyte Hemoglobin Equivalent (Ret-He) as a Potential Diagnostic Marker of Iron Deficiency Anemia among Bangladeshi Adults

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:5] [Pages No:128 - 132]

Keywords: Anemia, Iron deficiency anemia, Ret-He, Sysmex

   DOI: 10.5005/jp-journals-10018-1410  |  Open Access |  How to cite  | 


Anemia involving a variety of etiological sources constitutes a common side effect of long-term liver diseases. Anemia caused by an iron deficiency (IDA) is a prominent kind of anemia among various other types. Blood ferritin levels and other iron-related indicators can be used to identify anemia. On the other hand, it is now possible to quantify reticulocyte hemoglobin equivalent (Ret-He), which indicates the reticulocyte iron concentration. It would be useful to diagnose IDA immediately if Ret-He could evaluate the ID. The effectiveness of Ret-He to diagnose ID in Bangladeshi patients was investigated in an ongoing study. Whole bloodstream numbers, blood ferritin phases, and Ret-He concentrations were measured in a cohort of 215 Bangladeshi people. Hemoglobin (Hb) values less than 12 gm/dL were considered anemia. An individual was classified as iron deficient if their blood ferritin concentration was below 12 ng/mL. Participants were split into four groups for this study: non-ID groups with anemia, IDA, ID, and control groups. In comparison to patients with IDA and ID, the concentrations of Ret-He showed a downward tendency. Serum Ret-He levels were correlated with ferritin levels in the subjects. The measurement of the area around the intercept (AUC) for Ret-He on the ROC curve was 0.906, suggesting a correlation with diagnosis. The study's results provide optimism for the therapeutic use of Ret-He value as an indicator for identification in Bangladeshi patients.



Sidharth Harindranath, Jijo Varghese, Shivaraj Afzalpurkar, Suprabhat Giri

Standard and Extended Thromboprophylaxis in Patients with Inflammatory Bowel Disease: A Literature Review

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:9] [Pages No:133 - 141]

Keywords: Crohn's disease, Inflammatory bowel disease, Ulcerative colitis, Venous thromboembolism

   DOI: 10.5005/jp-journals-10018-1401  |  Open Access |  How to cite  | 


Patients with inflammatory bowel disease (IBD), both Crohn's disease and ulcerative colitis, frequently experience venous thromboembolism (VTE), a potentially fatal consequence. The pathophysiological mechanisms contributing to VTE include inflammation, modifications in coagulation factors, endothelial dysfunction, and platelet activation. Numerous pro-inflammatory cytokines and markers, such as tumor necrosis factor-alpha and interleukin-6, have a significant impact on the thrombotic cascade. Patients with IBD are more likely to suffer VTE for a variety of causes. Exacerbations of preexisting conditions, admission to the hospital, surgical intervention, immobilization, corticosteroid usage, central venous catheterization, and hereditary susceptibility all fit into this category. The mainstay of therapy for VTE in IBD patients includes anticoagulation that is individualized for each patient depending on the thrombosis site, severity, bleeding risk, and interaction with other drugs. In some high-risk IBD patients, such as those having major surgery or hospitalized with severe flare, preventive anticoagulation may play a role. However, the acceptance rate for this recommendation is low. Additionally, there is a subset of patients who would require extended thromboprophylaxis. The majority of the studies that looked into this question consisted of patients in the surgical setting. Emerging data suggest that risk factors other than surgery can also dictate the duration of anticoagulation. While extending anticoagulation in all patients may help reduce VTE-related mortality, identifying these risk factors is important. Hence, the decision to initiate prophylaxis should be individualized, considering the overall thrombotic and bleeding risks. This review explores the relationship between IBD and VTE, including risk factors, epidemiology, and prevention. A multifactorial approach involving aggressive management of underlying inflammation, identification of modifiable risk factors, and judicious use of anticoagulant therapy is essential for reducing the burden of VTE in this vulnerable population.



Mohammad Abdur Rahim, Swapan Kumar Singha, Syed Abul Foez, Sunia Sinha, Sheikh Mohammad Noor-E-Alam, Dulal Chandra Das, Faysal Ahmed, Musarrat Mahtab

Scientific Insights for Drug Development Based on Normal Habitat of Tribal Population of Manipur: An Observational Study Regarding the Implication of “Houttuynia cordata”

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:3] [Pages No:142 - 144]

Keywords: Bangladesh, Coronavirus diseases-2019, Houttuynia cordata, Manipur tribe, SARS-CoV2

   DOI: 10.5005/jp-journals-10018-1405  |  Open Access |  How to cite  | 


The development of new and novel drugs starts following a path of targeting possible candidate drug, elucidation their mechanism of action, animal studies, and finally after the completion of phases I/II and III clinical trials. The fundamental raw materials of drugs may be synthetic substances or plants. Many plants are habitually used in many countries as food or for the remedy of diseases. We found that a tribal population of Bangladesh use an herbal plant regularly and this plant has been shown to have potential positive effect for management of coronavirus disease-2019 (COVID-19). The present observation assessed the incidence and fatality of this community inhabitants due to COVID-19. Although a conclusion cannot be reached due to small sample size, this approach and theological concept may be helpful for the development, discovery, and innovation of new drugs for different pathological conditions.



Sheikh Mohammad Fazle Akbar, Sakirul Khan, Musarrat Mahtab, Mamun Al Mahtab, Takaaki Yahiro, Shohael Mahmud Arafat, Mohammad Abdus Sattar Sarker, Provat Kumar Podder, Mohammad Shawkat Hossain, Faiz Ahmad Khandokar, Mohammad Rashedul Hassan, Md Abdur Rahim, Muhammad Ali Ashraf, Rajib Saha Rony, Akira Nishizono

Recent Dengue Infection in Bangladesh: A Seasonal Endemic Progressing to Year-long Serious Health Concern

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:7] [Pages No:145 - 151]

Keywords: Bangladesh, Changing epidemiology, Dengue, Global emergency, Year-long endemic

   DOI: 10.5005/jp-journals-10018-1408  |  Open Access |  How to cite  | 


Dengue represents one of the most dangerous mosquito-borne viral diseases. Although the disease has been prevalent around the globe over the centuries, recent outbreaks of dengue have devasted the healthcare delivery system of many countries. Being a global infection, dengue virus (DENV) is endemically present mainly in Latin America and Caribbean countries as well as countries in South Asia. The recent outbreak of DENV infection has indicated an exceptional outbreak of DENV in some countries in South Asia. There has been a serious endemic of DENV during 2019. After a heterogeneous pause, another severe outbreak of DENV was reported in some Asian countries in 2023. Among the Asian countries, Bangladesh has reported an acute upsurge of DENV infection in 2023 with record numbers of fatalities. However, this pattern of DENV has not been detected in neighbors of Bangladesh, such as India or other countries in Southeast Asia. This provides an emergent task of dissecting the present DENV infection in Bangladesh from different angles to get insights for future containment of the DENV infection, not only in Bangladesh but also in other DENV endemic areas or DENV-native areas.



Ruksana Raihan, Sheikh Mohammad Fazle Akbar

A Narrative Review on the Specific Pattern of HBV Genotype in Bangladesh: Clinical Implications for Management

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:7] [Pages No:152 - 158]

Keywords: Chronic hepatitis B, Liver cancer, Liver cirrhosis

   DOI: 10.5005/jp-journals-10018-1412  |  Open Access |  How to cite  | 


Background and aims: Bangladesh's unique epidemiological landscape presents an intriguing puzzle. This South Asian nation, with its complex sociodemographic and environmental factors, is home to a diverse array of hepatitis-B virus (HBV) genotypes, identified as Genotype C, with Genotypes D and A also making a significant contribution to the viral landscape. Reviewing such insights is necessary not only to underscore the country's regional diversity in HBV strains but also to bring into focus the clinical implications these genetic variations may have on disease progression and management. Methods: A thorough database search covered various sources using relevant keywords like “Hepatitis B virus genotypes”, “HBV genotypes in Bangladesh”, and “HBV clinical implications”. The review synthesized findings and analyzed HBV genotype prevalence and clinical implications in Bangladesh. Results: Genotypes C and D collectively represent 82% of chronic hepatitis-B infection (CHB) cases in Bangladesh, underscoring their regional prevalence. The geographic context is pivotal in understanding HBV infection dynamics and disease progression in this area. Notably, genotype C and the presence of A1762T/G1764A mutations appear to have a distinct impact on disease development, potentially affecting the immune response in CHB patients. This highlights the need for tailored management approaches in this specific region. Further research is vital to confirm and elaborate on these findings, particularly in relation to how these mutations influence the host's immune response. Conclusion and clinical significance: In summary, studies on HBV genotypes in Bangladesh stress the need for genotype-specific clinical considerations and more research to improve diagnostics and therapies.



Mirza Faraz Saeed, Taima Almubarak, Sara Khalaf, Ahmet Aslan, Isam Mazin Juma

A Review of the Literature, the Detection and Treatment of Colorectal Cancer during Pregnancy: A Case Study!

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:4] [Pages No:159 - 162]

Keywords: Case report, Colorectal cancer, Diagnosis, Pregnancy, Treatment

   DOI: 10.5005/jp-journals-10018-1398  |  Open Access |  How to cite  | 


Background: Colorectal cancer (CRC) during pregnancy is rare and presents diagnostic and therapeutic challenges. Aim: This case report focuses on a patient who presented with colorectal cancer during pregnancy. Case description: A 45-year-old female primigravid, pregnant woman, in the 20th week of gestation presented with complaints of multiple episodes of bloody diarrhea and tenesmus for the past 3 weeks. This was accompanied by poor appetite and weight loss (15 kg) since the onset of pregnancy. The patient also complained of lower back and abdominal pain. Investigations confirmed an obstructing rectosigmoid mass (15 cm) that could not be passed. The patient's pregnancy was terminated, and chemotherapeutic treatment was initiated. Clinical significance: With the clinical manifestations of CRC during pregnancy being non-specific, tumors are usually discovered at an advanced stage. This poses a challenge for physicians to treat such cases. This case contributes to the growing literature on pregnancies complicated by CRC and highlights the importance of high clinical suspicion and the need for a multidisciplinary team in tailoring treatment regimens in accordance with patient-centered care. Conclusion: This case report highlights the rarity of colorectal cancer during pregnancy and the challenges faced in the diagnoses and treatment.



Mohd Fazl Ul Haq, Bilal Ahmad Wagay, Ajaz Ahmad Malik, Munir Ahmad Wani, Gowhar Aziz Bhat

Jejunogastric Intussusception: A Rare Case Report Study

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:3] [Pages No:163 - 165]

Keywords: Case report, Gastric cancer surgery, Gastrojejunostomy, Jejunogastric intussusception, Retrograde intussusception, Shock

   DOI: 10.5005/jp-journals-10018-1415  |  Open Access |  How to cite  | 


Jejunogastric intussusception (JGI) is a rare, potentially fatal complication of gastrojejunostomy following any gastric resection or gastric bypass surgery. Very less no of cases have been reported to date in the literature, with a very low incidence of <0.1%. Early recognition of JGI followed by prompt intervention is necessary to avoid any serious complications of gut gangrene or even possible death. It carries a mortality rate of approx. 10% of patients subjected to early intervention within 24 hours as compared to 50% in cases where surgery was delayed for more than 48 hours. The usual presenting complaints include a triad of palpable epigastric mass, hematemesis, and epigastric pain with only 50% of patients having this classical presentation. We here, report a middle-aged male with JGI which was diagnosed and managed at our center with emergency surgical intervention.



Romman Fatima, Viquasuddin Mohammed, Afra Fatima, Syed Ilyaz

Case of Autoimmune Hepatitis

[Year:2023] [Month:July-December] [Volume:13] [Number:2] [Pages:3] [Pages No:166 - 168]

Keywords: Autoimmune hepatitis, Bilirubin, Biopsy, Case report, Cirrhosis of the liver

   DOI: 10.5005/jp-journals-10018-1413  |  Open Access |  How to cite  | 


Autoimmune hepatitis (AIH) accounts for cases of chronic liver disease with greater incidence in females than males. It has a bimodal distribution in the age group peaking around pubertal periods and later in the fourth to sixth decade of life. It is characterized by continual hepatocellular inflammation and necrosis which bears the potential to progress to fibrosis and cirrhosis. Approximately a third of the patients manifest with features of acute hepatitis while some patients may progress to chronic liver disease with acute liver failure manifesting in the form of jaundice and coagulopathy. Management has long involved administration of corticosteroids alone or in association with other immunosuppressants like azathioprine to achieve long-term remission. Response to therapy is significantly variable as few patients achieve remission while some may relapse, thereby becoming candidates requiring lifelong therapy. It can either present as insidious onset or acute with manifestations ranging broadly from fatigue malaise, lethargy right upper quadrant pain weight loss anorexia, and jaundice, where up to one-third of patients may have progressed to frank cirrhosis at the time of diagnosis. A 62-year female presented with complaints of facial puffiness more around the eyes, associated with profoundly reduced appetite, yellowish discoloration of the skin, conjunctiva since 1 month, and sudden onset generalized itching not associated with fever, joint pains, weight loss, vomiting, loose stools, rash, or bleeding manifestations. She was admitted for further evaluation and workup. Liver function test revealed predominant unconjugated hyperbilirubinemia with direct bilirubin of 0.7 mg/dL and indirect bilirubin of 1.6 mg/day and transaminitis. Further investigations showed significantly elevated immunoglobulin G (IgG) and 1:80 titer of antinuclear antibodies (ANAs). In view of the high suspicion of autoimmune etiologies, the patient was subjected to a liver biopsy that confirmed cirrhosis with moderate interface hepatitis in the background of negative viral serologies and substance abuse history. She was started on a steroid course on a monthly follow-up basis to ensure biochemical remission.


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