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Upcoming Event

Message

Dear Colleagues,

On behalf of the Organizing Committee of APASL STC Islamabad 2019, it is my great pleasure to welcome all the participants across the country and from abroad to attend the esteemed Conference on Viral Hepatitis from December 5-8, 2019 at Serena Hotel Islamabad, Pakistan. The theme of the meeting is Elimination of Viral Hepatitis by 2030 “From Dream to Reality”.

It is indeed an honor that PSSLD will be holding Third APASL Single Topic Conference this year. PSSLD is working with clear objective to create awareness among health care workers and to sensitize them to the burden of Liver diseases and its implications in the community.

The meeting’s content and activities are tailored to a wide audience of Hepatologists, Gastroenterologists, General practitioners and Postgraduate students. In this meeting we have included several interactive sessions with live audience response. Scientific program has CME credits and offers fantastic updates for consultants, trainees and primary care physicians. Faculty will include international key opinion leaders, mainly from the Asia Pacific region as well as from home.

We urge our colleagues to participate enthusiastically and honor us with their presence. This will be an exciting and educational meet for all.

All the committees are working very hard to make it a memorable event. It would be a great opportunity to meet and network with like-minded colleagues.

It will be winter in Islamabad which is surrounded by Margalla Hills and you will need warm clothing if you intend to move around. Remains of ancient civilization of Ghandara (Taxila) are just nearby (45 minutes’ drive) and if you wish to have a trip to snow covered mountains it is just 40 Km away.

Looking forward to welcome you all in the beautiful city of Islamabad.

Prof. Masood Siddiq
President PSSLD
Chair Organizing Committee

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Highlights

Pre-Conference Workshop

Workshops for PG Trainees & Family Physicians

State of the Art Lectures

Scientific Symposia

Poster Presentation

Free Papers & Presentations

Exhibition

Social Program

Young Investigator Awards

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Program Summary

It is indeed an honor that PSSLD will be holding APASL Single Topic Conference this year. We are pleased and honored to inform our esteemed colleagues and participants that a four-day conference on “Elimination of Hepatitis from Dream to Reality” will be held on Dec 5-8, 2019.

Day 1

5th Dec There will be two sessions on research methodology, analysis and how to get the paper published for the post graduates, from 0900 to 1000 hours and then again from 1130 to 1330 hours. This will be followed by a series of case presentations by the trainees from different departments of Gastroenterology across the country which will be discussed threadbare by the attending faculty, both foreign and local.

Day 2

6th Dec The day will be divided into 6 sessions. Sessions I,II,III and V will be dedicated to public health and prevention of hepatitis. Session IV will be the Inaugural Session, and the last session (VI) will be reserved for Free Papers presentations.

Day 3

7th Dec Again the day will be divided into six sessions, for Diagnostic evaluations, Hepatitis Delta, B, C, and chronic liver disease complications.

Day 4

8th Dec The last day there will be only three sessions. First session will be second part of Free Papers, second session will be for hepatocellular carcinoma, and third dedicated to NASH. Lastly there will be simultaneous workshops on NASH, HCC, HCV and Liver disease in Pregnancy.

Event Schedule

Here is our event schedule

Other Details

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General Information

Language

The official language of the conference is English, simultaneous translation will not be provided.

Climate

In December temperature in Islamabad range from 2C – 24C.

Time Zone

The time zone in Pakistan is Greenwich Mean Time (GMT) + 5 hour.

Banking and Exchange

The Pakistan monetary system is Rupee. Foreign currency may be changed at banks during normal banking hours (09:00-16:00), or hotels, airports and in exchange offices. All major credit cards are acceptable in most hotels, restaurants and shops.

Liabilities & Insurance

The organizer is not able to take any responsibility whatsoever for injury or damage involving persons and property during the meeting. Participants are advised to take out their own personal travel and health insurance for their trip.

Official Letter of Invitation

A personal letter of invitation can be sent to the participants on request.

Visa Requirements

Participants are requested to check with the Pakistani embassy/consulate in their home country or with their travel agency for visa requirements. It is the responsibility of the participant to obtain a visa if required.

Food & Beverages

Business lunches and coffee/tea during breaks (as indicated in the program) are included in the registration fee.

National Airline

Pakistan International Airline is the national airline which operates in all major European, North American and Asian countries. Other airlines operating in Pakistan are: Emirates Airline, Gulf Airlines, Qatar Airlines, Etihad Airlines, British Airlines, Turkish Airlines, Royal Thai Airline Malaysian Airlines, Air China and Thai United.

Hotel Accommodation

Serena Hotel Islamabad: Khayaban-e-Suhrwardy, G-5, Islamabad.
Phone: (+92- 51) 2874000.
Website: www.serenahotels.com

Marriott Hotel Islamabad: Agha Khan Rd, F-5/1 Shalimar 5 Islamabad.
Phone: (+92- 51) 2826121
Website: www.marriott.com

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Event Speakers

  • DR. Rino Alvani Gani, SpPD KGEH

    Premier Bintaro Hospital Jl. MH Thamrin No. 1
    Sector 7 Bintaro Jaya
    Tangerang Selatan 15224 - Indonesia
    Specialty:
    • Internal Medicine
    • Consultant Gastro Hepatology
    Medical Qualifications / Experience:
    • Medical Staff of the Department of Internal Medicine RSCM / FKUI
    • Premier Bintaro Hospital
    Medical Education:
    • Faculty of Medicine, University of Indonesia, 1987
    • Internal Medicine Specialist Education FKUI, 1996
    • Gastroenterology-Hepatology Consultant FKUI-PAPDI, 2000
    • Medical Virology & Jichi Medical School, Japan, 1998
    Professional Memberships:
    • Member IDI
    • PAPDI Members
    • PPHI Secretary of PEGI
    • PGI Members
  • Fasiha Kanwal, M.D., MSHS

    Houston VA HSR&D Center for Innovations, Quality,
    Effectiveness, and Safety (Office)
    Texas 77021United States
    Positions:
    • Editor-in-Chief
      • Clinical Gastroenterology and Hepatology
    • Professor and Section Chief
      • Medicine
      • Gastroenterology
      • Baylor College of Medicine
      • Houston, Texas
    • Member
      • Dan L Duncan Comprehensive Cancer Center
      • Baylor College of Medicine
      • Houston, Texas, United States
    Qualifications:
    • M.S.H.S from UCLA School Of Public Health, United States, 2004
    • M.D. from King Edward Medical College, Pakistan, 1995
    Certifications:
    • Missouri Medical License
    • National Board of Medical Examiners
    • American Board of Internal Medicine
    • ABIM Gastroenterology Certification
    • ABIM Transplant Hepatology Certification
    Honors & Awards:
    • Editor-in-Chief>
    • Annual meeting distinguished poster
    • Emerging Leaders in Gastroenterology Award
    • Plenary session at the VA National HSR&D Meeting
    • Research Excellence in GI and Liver (REGAL) Award
    Professional Interests:
    • Process and outcomes of care in patients with chronic liver diseases
    • Quality management in liver disease
    • Medical decision-making
    • Patient reported outcomes (health related quality of life)
    • Cost effectiveness analyses
    • Cirrhosis and related complications
    Learnmore
  • LAI WEI, MD

    Premier Bintaro Hospital Jl. MH Thamrin No. 1
    Sector 7 Bintaro Jaya
    Tangerang Selatan 15224 - Indonesia
    Personal Profile:

    Lai Wei is a Professor of Hepatology & Medicine, and is the Director of Peking University Hepatology Institute since 2004 and Chief of Department of Hepatology at Peking University People’s Hospital since 2001. His current research interests involve antiviral treatment of hepatitis B and C. Dr. Wei is the President of the Chinese Society of Hepatology. He served to develop the Chinese Guideline for Management of Hepatitis B, and Management, Diagnosis and Prevention of Hepatitis C virus Infection. In addition, Dr Wei is involved in Kidney Disease Improving Global Outcome to develop a Guideline for HCV Infection, Diagnosis, Prevention and Management in Kidney Disease and contributes to APASL for hepatitis C guideline.

  • Tehami, Dr Nadeem A

    BSc, MRCP (UK), MRCP Gastroenterology,
    FEBGH, FRCP (Glasg)
    Specialty:
    • Gastroenterology
    Sub-specialty:
    • Hepatology (liver) and hepatobiliary (gallbladder and bile ducts) medicine
    Training & Education
    • Undergraduate education/training - Quaid-e-Azam University, Army Medical College, Pakistan (2002)
    • General medical SHO rotation - London South Thames rotation (2004-07)
    • Gastroenterology/hepatology training in various institutions in London, Glasgow and Birmingham between 2007 and 2014 including West Midlands gastroenterology/hepatology rotation
    • Transplant hepatology module - University Hospital of Birmingham (2012-13)
    • HPB endoscopy fellowship - Heart of England NHS Foundation Trust (2013-14)
    Experience:

    Dr Tehami is a consultant gastroenterologist who specialises in hepatology and hepatobiliary medicine. He joined UHS in August 2018. He previously worked as a consultant hepatologist at Shrewsbury and Telford Hospitals NHS Trust for over three years before joining UHS.

    He looks after patients with a wide range of hepatopancreaticobiliary (HPC) problems, but has a specialist interest in HPB endoscopy (ERCP/EUS). His clinical role is divided into inpatient ward work, outpatient clinics and endoscopy lists.

    Dr Tehami's main clinical interests are HPB medicine and endoscopy, endoscopy teaching and training, and improving patient care through education of other health professionals and service development.

    Current roles:
    • MRCP PACES examiner
    • Member of the MRCP part 1/2 question writing group
    • Advance life support instructor (Resus Council UK certified)
    • JAG accredited endoscopy trainer
    • Part of the faculty on PACES and endoscopy training courses overseas
    • Reviewer for Journal of Medical Sciences KMC
    Key Achievements:
    • Dr Tehami cofounded an organisation called PAGHE and initiated the overseas doctors development programme. Under this banner a national conference was arranged for junior doctors which was attended by over 100 delegates. The purpose was to support and guide international medical graduates for the best patient care in the NHS.
    • Dr Tehami has conducted several interview courses overseas for prospective RCP MTI (Medical Training Initiative) programme applicants as an effort to support NHS recruitment.
    • Dr Tehami has an active interest in telemedicine and FOAMed. He has produced several eductional videos for patients and endoscopy nurses.
    Research:

    Below is a selection of Dr Tehami's most recent publications:

    • Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation. Gut. 2015 Jul 1;64(7):1111-9.
    • Comparing clinical presentations, treatments and outcomes of hepatocellular carcinoma due to hepatitis C and non-alcoholic fatty liver disease. QJM: An International Journal of Medicine. 2017 Feb 1;110(2):73-81.
    • Isolated unilateral tongue oedema: the adverse effect of angiotensin converting enzyme inhibitors. Current drug safety. 2012 Nov 1;7(5):382-3.
    • Extrahepatic manifestations of hepatitis C. Frontline gastroenterology. 2013 Nov 4:flgastro-2013.
    • Probiotics' Effects on Perception of Health and Bowel Frequency: A Double Blind Randomized Placebo Controlled Clinical Trial. Gastroenterology. 2017 Apr 1;152(5):S819.
  • Norah Terrault, MD

    Professor Emeritus, Medicine
    513 Parnassus Ave, MSB
    San Francisco, CA 94117
    Education and Training:
    • University of California, San Francisco Post-Doc Fellow/Scholar, Medicine, 1995
    • University of California, San Francisco, Clinical Fellowship, Gastroenterology
    • University of California, San Francisco, Residency
    • University of Alberta, M.D., School of Medicine, 1987
    Research Activities and Funding:
    • Bay Area Hepatitis C Cooperative Research Center
      Role: Co-Investigator (Jun 15, 2010 - May 31, 2015)
    • Hepatitis B Research Network (HBRN): Natural History and Treatment Studies
      Role: Principal Investigator (Sep 30, 2008 - May 31, 2020)
    • Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)
      Role: Principal Investigator (Jun 15, 2002 - Jun 30, 2020)
    • Resistance to Antiviral Therapy in Chronic Hepatitis C
      Role: Principal Investigator (Aug 1, 2001 - Apr 30, 2007)
    Learnmore
  • Wan-long Chuang

    Vice Superintendent, Kaohsiung Medical University Hospital
    Professor Department of Medicine, Kaohsiung Medical University
    Education:
    • M.D, School of Medicine, Kaohsiung Medical University
    • MS, Postgraduate Institute, Kaohsiung Medical University, Taiwan
    • PhD, Postgraduate Institute, Kaohsiung Medical University, Taiwan
    Experience:
    • Lecturer, Department of Medicine, Kaohsiung Medical University
    • Associate Professor, Department of Medicine, Kaohsiung Medical University
    • Director, Faculty of Medicine, School of Medicine, Kaohsiung Medical University
    • Chief, Hepatobiliary Division, Department of Internal Medicine
    • Chief, Department of Preventive Medicine
    • Director, Ultrasound Center
    License:
    • Specialist of Taiwan Society of Internal Medicine
    • Specialist of the Gastroenterology Society of Taiwan
    • Specialist of Taiwan society of Ultrasound in Medicine
    Professional Specialty:
    • Hepatobiliary and Pancreatic Disease
    • Abdominal Ultrasound Examination
    • Hepatitis Treatment
  • XIAOYUAN XU, PHD

    China
    Personal Profile:

    Professor Xiaoyuan Xu graduated from thre First Hospital of Lanzhou Medical College in 1988. He is currently a chief of the institue of infectious disease,Peking University.Professor Xu is also a vice chief of the Department of Infectious Disease,Peking Unicersity First Hospital.

    Professor Xu is a standing committee member of the Liver Disease Association of China; a vice chairman of the Liver Disease Association of Beijing,China;a vice leader of the Group of AIDS,Infectious Disease Association of China;a membership of Chinesee Medical Association.Profeesor Xu is editor of National Medical Jornal of China;Chinese Journal of Hepatology;Clinical Internal Medicine Journal of China and World Chinese Journal of Digestology.Professor Xu has published 80 papers about HIV/AIDS/HBV/HCV/SARS.

  • ZHONGPING DUAN, MD, PHD

    President of Chinese Society of Hepatology
    Chinese Medical Association
    Personal Profile:

    Prof. Duan is the Vice President of Beijing Youan Hospital Capital Medical University and President of Chinese Society of Hepatology, Chinese Medical Association. He is also the director of Translational Hepatology Institute of Capital Medical University and Director of Liver Division of Wu Jieping Medical Foundation. He is a Co-chief Editor of Journal of Clinical Hepatology and Chinese Journal of Gastroenterology and Hepatology. He has been the Chairman of Chinese Severe Liver Diseases Meeting (2007-2018).

    Prof. Duan has been awarded Beijing Science and Technology Progress Prize, Chinese Medical Science and Technology Prize, Wu Jieping Prize for Medical Innovation; Science and Technology Progress Prize of Hebei Province and National Prize for Progress in Science and Technology.

  • Jidong Jia

    Professor of Medicine & Director,
    Liver Research Center, Beijing Friendship Hospital,
    Capital Medical University, China
    Personal Profile:

    He received his doctor;s degree from Capital Medical University, Beijing China and finished his postdoctorial training at Klinikum Benjamin Franklin, Free University of Berlin, Germany. His clinical interests include the chronic viral hepatitis, autoimmune and cholestatic liver diseases. His main research work includes the pathogenesis and treatment of l liver fibrosis.

    He is the President-Elect of IAS, Past President of APASL (2009-2010) and Immediate Past President of the Chinese Society of Hepatology. He currently serves China Foundation of Viral Hepatitis Prevention and Control as vice president, and CEVHAP as Executive Council Member. He also serves as associate editor for Journal of Gastroenterology & Hepatology and Hepatology International.

  • Professor Dr. A. Kadir Dökmeci

    Ilgaz / Çankiri Turkey
    Education:
    • 1954-1965 Primary and High School Ankara
    • 1965-1971 Ankara University Faculty of Medicine
    • 1971-1976 Assistant, Department of Internal Medicine, AÜTF
    • 1976-1978 Assistant, Department of Gastroenterology, AÜTF
    • 1978-1979 Chief Assistant, Department of Gastroenterology
    • 1979-1979 Japanese Course, Osaka, Japan, (6 Months)
    • 1979-1981 Study, training and research, 1st Internal Medicine Clinic of Chiba University School of Medicine
    • 1981-1981 Visiting Researcher, Goethe University Medical School Gastroenterology Clinic (1 Month)
    • 1981-1981 Observer Specialist, Northwestern University School of Medicine.Chicago, (20 Days) USA
    • 1981-1982 Gastroenterology Specialist, AÜTF
    • 1982-1988 Associate Professor, Department of Gastroenterology, AÜTF
    • 1988 Appointment as Professor, Department of Gastroenterology, AÜTF
    • 1988-1989 Visiting Professor .Chiba University. Chiba, Japan
    • 1989 ERCP Course. Middlesex Hospital. London, England
    • 1989-1994 Professor, Department of Gastroenterology, AÜTF
    • 1994-1997 Presidency of Internal Medicine, AÜTF
    • 1997-2000 Department of Gastroenterology, AÜTF
    • 2002-2003 Visiting Professor, Department of Gastroenterology, University of California, Irvine, Los Angeles, USA
    • 2003 Professor, Gastroenterology, AÜTF
    Award:
    • INOHANA Award Contribution to Turkish-Japanese cooperation in the field of Gastroenterology
    Education:
    • Ankara University Medical School, Turkey
    • Chiba University School of Medicine, Japan
    • Gethoe University, Frankfurt, Germany
    • University of Calfornia, Irvine, USA
    Diplomas:
    • Medical Diploma
    • Internal diseases
    • Gastroenterology
    Memberships:
    • 1973 Turkish Gastroenterology Association
    • 1994-1998 Member of the Board
    • 1984 International Association for the Study of the Liver (IASL)
    • 1985 Turkish Ultrasonography Association
    • 1988 Japanese Society of Gastroenterology
    • 1990 Gastrointestinal Endoscopy Association
    • 1990-1998 Member of the Board
    • 1991 Turkish-Japanese University Association
    • 1991-1995 Member of the Board
    • 1991-1994 Member of the Regulatory Commission for Gastroenterology Drugs of the Ministry of Health
    • 1992 Turkey's Liver Research Association
    • 1994-2000 Presidency of Gastroenterology Drugs Regulatory Commission of Ministry of Health
    • 1996 Turkish Society of Surgical Hepato-Pancreato-Bilier Diseases
    • 1996 Turkish-Japanese Foundation
    • 2002 Hepato-Bilio-Pancreatology Association (HEBIPA) President
    • 2003 International Society of Gastroenterology and Surgery
  • Prof. Gregory Dore

    Professor and Program Head
    Viral Hepatitis Clinical Research Program, Sydney
    Personal Profile:

    Professor Dore is Head, Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, and Infectious Diseases Physician, St Vincent’s Hospital, Sydney, Australia. He has been involved in viral hepatitis and HIV epidemiological and clinical research, clinical care and public health policy for 20 years. He has developed extensive national and international collaborations, and is internationally recognized in the areas of HCV natural history and epidemiology, therapeutic strategies for acute and chronic HCV infection, particularly among people who inject drugs, and HCV elimination strategies.

    Professor Dore established the St Vincent’s Hospital viral hepatitis service in 1999, and has led its development into one of the leading national and international hepatitis C treatment services, with a particular focus on marginalised populations including people who inject drugs and homeless persons.

    Qualifications:
    • 2001 PhD, University of New South Wales
    • 1997 MPH, University of Sydney
    • 1995 FRACP, Royal Australasian College of Physicians
    • 1987 BSc, University of New South Wales
    • 1987 MBBS, University of New South Wales
    Grants:

    Major Category 1 Grants

    • NHMRC: Practitioner Fellowships (2012-2016: $523K; renewed for 2017-2021: $569K).
    • NHMRC Program Grant as CI (2014-2018: Hepatitis C infection: epidemiology, pathogenesis, and treatment; $5,428K, $1,307K to Dore)
    • NHMRC Partnership Grants as CI (2014-2019: Surveillance and Treatment of Prisoners with hepatitis C (SToP-C), $1,495K; 2016-2020: Enhancing hepatitis C virus among injecting drug users in the opiate pharmacotherapy setting, $1,490K).
    • NIH R01 Grants as CI (2015-2020: A randomised study of interferon-free treatment for recently acquired hepatitis C in people who inject drugs and people with HIV coinfection (REACT study), $US 3,700K; 2011-2016: International Collaborative of prospective studies of HIV and Hepatitis in IDU, $2,289K).
    Award:
    • 2007, 2012, 2017 NHMRC Practitioner Fellowship
    • 2007 Frank Fenner ASID Award for Advanced Research in Infectious Diseases
    • 2016 Fellow of Australian Academy of Health and Medical Science
  • Prof. Jinlin Hou

    Director and Professor of
    The Hepatology Unit
    &
    Department of Infectious Diseases
    Personal Profile:

    Professor Jinlin Hou is the Director and Professor of the Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China. Professor Hou is the president of APASL 2017 and the president of Chinese Medical Association of Infectious Diseases(2013-2016. Professor Hou joined the University Department of Medicine of Nanfang Hospital in July 1984. Between 1993 and 1994,he received training in the Department of Medicine at St. Mary’s Hospital Medical School in London, UK. Between 2000 and 2001, Professor Hou was a visiting Fellow at the Institute of Hepatology, London, UK. He has been invited to deliver talks at both national and international liver conferences owing to his expertise in viral hepatitis and other liver diseases. His current research interests include the clinical management of liver and Infectious Diseases and the molecular virology and immunology of hepatitis virus infection. He has published more than 500 articles in both national and international journals, including GUT, Hepatology, Journal of Immunology,Journal of Hepatology, Science,LANCET Infect Dis, NEJM et al.

  • NECATİ Örmeci

    Departments of Medical Sciences
    Personal Profile:

    I was born in 1952 in the Senirkent district of Isparta. I finished primary and secondary school here. In 1976, I graduated from Ankara University Faculty of Medicine. About a week after my graduation, I became an assistant in the Department of Internal Medicine at the same faculty. Between 1983-85, I specialized in Gastroenterology and in 1985 I became an assistant professor in Ankara University Faculty of Medicine, Department of Gastroenterology. I went to Japan in 1985 and studied at Tokyo Women's Medical Collage on diagnostic endoscopy, endoscopic ultrasonography and endoscopic interventions. I returned from Japan at the end of 1986. I became an associate professor in 1988. In 1990, with a scholarship from TUBITAK, I also worked in Tokyo National Cancer Center for 4 months on endoscopy, cytology and histepatology of early gastric cancer. I became a professor in 1994. In 1999, I worked for a month at the Cleveland Clinic in Miami to improve my knowledge and experience. I am still working in Ankara University Faculty of Medicine Department of Gastroenterology. In September 2006, I was elected as the Head of the Internal Medicine Department of our faculty.

  • Bilal Hameed, MD

    Associate Professor, Hepatologist
    Personal Profile:

    Dr. Bilal Hameed is specialist who cares for patients with liver disease. His expertise includes providing care before and after liver transplantation.

    Hameed earned his medical degree at Dow University of Health Sciences in Pakistan and completed an internal medicine residency at the University of Minnesota. He completed a fellowship in gastroenterology at the University of Minnesota and a fellowship in transplant hepatology at UCSF.

    In addition to authoring numerous peer-reviewed articles, Hameed has received many awards and honors in his field. He is a member of the American Association for the Study of Liver Diseases, American Gastroenterological Association and American Society of Transplantation.

    Board Certification:
    • Transplant Hepatology, Amer Bd of Internal Medicine/Transplant Hepatology
    • Gastroenterology, American Board of Internal Med/Gastroenterology
    Education:
    • Dow School of Medicine 2000
    Residencies:
    • University of Minnesota, Internal Medicine 2006
    Fellowships:
    • University of Minnesota, Gastroenterology 2009
    • UCSF Medical Center, Transplant Hepatology 2010
    Selected Research and Publications:
    1. Kim D, Cholankeril G, Li AA, Kim W, Tighe SP, Hameed B, Kwo PY, Harrison SA, Younossi ZM, Ahmed A. Trends in hospitalizations for chronic liver disease-related liver failure in the United States, 2005-2014. Liver Int. 2019 May 13.
    2. Leventhal TM, Gottfried M, Olson JC, Subramanian RM, Hameed B, Lee WM. Acetaminophen is Undetectable in Plasma From More Than Half of Patients Believed to Have Acute Liver Failure Due to Overdose. Clin Gastroenterol Hepatol. 2019 Feb 05.
    3. Trauner M, Gulamhusein A, Hameed B, Caldwell S, Shiffman ML, Landis C, Eksteen B, Agarwal K, Muir A, Rushbrook S, Lu X, Xu J, Chuang JC, Billin AN, Li G, Chung C, Subramanian GM, Myers RP, Bowlus CL, Kowdley KV. The Nonsteroidal Farnesoid X Receptor Agonist Cilofexor (GS-9674) Improves Markers of Cholestasis and Liver Injury in Patients With Primary Sclerosing Cholangitis. Hepatology. 2019 Jan 19.
  • Professor Salimur Rahman

    Professor of Hepatology Bangabandhu Sheikh Mujib
    Medical University Shahbagh,
    Dhaka-1000, Bangladesh.
    Personal Profile:

    Professor Salimur Rahman is a veteran Hepatologist of Bangladesh and at present working as professor of hepatology Bangabandhu Sheikh Mujib Medical University which is the only medical university of this country. He is one of the founders of the discipline in this country. He is a co-editor of 1) ‘Liver: A Complete Book on HepatoPancreato-Biliary Diseases’ and 2) ‘Comprehensive Text Book of Hepatitis B’ published by Elsevier and Jaypee respectively. Professor Rahman has over 100 publications in international and regional journals. He is Editor-in-Chief of Euroasian Journal of Hepato-Gastroenterolgy, the official publication of Euroasian Gastroenterological Association and Viral Hepatitis Foundation Bangladesh. He is the current President of Association for the Study of the Liver, Dhaka, Bangladesh – the national association of Hepatologists of the country and the Senior VicePresident of Association of Physicians of Bangladesh – the premier platform of specialist physicians of Bangladesh. He is also the founder Chairman of Viral Hepatitis Foundation Bangladesh. He served as member national committee for Hepatitis B virus in Bangladesh and presently serving as executive committee member of Asian Pacific Association for the study of the Liver (APASL). He is the current president of South Asian Association for the Study of Liver (SAASL). Professor Salimur Rahman is a leading interventionist of Bangladesh and has pioneered the transformation of Hepatology from a theoretical to an interventional super-specialty in this country. He is a senior faculty member of the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University. He is a Fellow of Bangladesh College of Physicians and Surgeons, Royal College of Physicians of Edinburgh and Royal College of Physicians of Dublin.

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Organizing Committee

Patron

Prof. Wasim Jafri

President & Chair Organizing Committee

Prof. Masood Siddiq

Steering Committee
  • Prof. Wasim Jafri
  • Prof. Saeed Hamid
  • Prof. Masood Siddiq
  • Prof. Zaigham Abbas
Organizing Committee
  • Prof. A.A Durrani
  • Prof. Muzzafar Latif Gill
  • Prof. Javaid Aslam Butt
  • Prof. Tassawar Hussain
  • Prof. Shoaib Shafi
  • Prof. Faisal Saud Dar
  • Prof. Ghias-un-Nabi Tayyab
  • Dr. Mashood Ali Khan
  • Dr. Adil Naseer
  • Dr. Arshad Abbasi
  • Dr. Altaf Baqir Naqvi
  • Prof. Wazir Sheikh
  • Prof. Bashir Sheikh
Scientific Committee
  • Prof. Amjad Salamat (Chair)
  • Dr. Muhammad Salih (Co-Chair)
  • Dr. Najam ul Hassan Shah
  • Prof. Farrukh Saeed
  • Dr. Muhammad Naseet
  • Prof. Zafar Ali
  • Dr. Lubna Kamani

Form Submissions

SINGLE TOPIC CONFERENCE - 2019

Abstract should be developed according to following format and should not be of more than 250 words. Last date for Abstract Submission is October 31, 2019

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Presentations

S. No. Author Title of Presentation
1 Azhar Hussain
CAN WE REPLACE TRANSIENT ELASTOGRAPHY (FIBROSCAN) WITH CHEAP BIOMARKERS? A CROSS SECTIONAL STUDY AT LAHORE GENERAL HOSPITAL, LAHORE

Azhar Hussain (3rd Year MBBS), Usama Ahmad Yousuf (3rd Year MBBS), Junaid Mushtaq, Bilal Nasir, Ghias ul Hassan, Israr Ul Haque Toor, Ghias Un Nabi Tayyab, Muhammad Asif Gull, Gastroenterology Department , Lahore General Hospital Lahore

AIMS: To assess the validity of Serum Aminotransferase Levels i.e. ALT & AST, Albumin and Bilirubin as fibrosis biomarker, we compared their serum levels with fibro scan for the fibrosis staging and predicting its progression in Pakistani population.

METHODS: The prospective cross-sectional study was conducted in medicine unit 1 and hepatitis clinic of Lahore General Hospital, Lahore starting from 11 Feb 2017 to 29 Dec 2018. We studied 1376 HCV infected patients, and got CBC, LFTs, ELISA, PCR and fibroscan done to diagnose ongoing hepatitis C infection. In order to differentiate HCV fibrosis progression, we compared the effectiveness of readily available serum aminotransferase Levels i.e. ALT & AST, Albumin and Bilirubin with fibroscan.

RESULTS: Area Under the Curve for F0-F3 was less than 0.6 except ALT indicating that none of Albumin, Bilirubin, ALT or AST can be used as diagnostic biomarker for predicting F0-F3. But, an ALT for F4 stage, the sensitivity was 57.3, specificity 50.0 with AUC=0.698.AST>40 had sensitivity of 82.6 and specificity of 79.0 for F4 stage with AUC=0.707. Bilirubin >0.95 had sensitivity of 45% and specificity of 79.0 for F4 stage with AUC=0.651. Albumin can not be used as diagnostic biomarker for all the stages of fibrosis (F0-F4).

CONCLUSION: An AST, ALT and Bilirubin can predict cirrhosis in patients with chronic hepatitis C infection. In these patients, a liver biopsy and fibroscan may not be necessary in these patients.

KEYWORDS: Transient elastography, cirrhosis, AST, ALT and Bilirubin Hepatitis C, Blood Platelets, Fibro scan score.

Can we replace Transient Elastography (Fibroscan) with cheap biomarkers? A cross sectional study at Lahore General Hospital, Lahore
2 Azhar Hussain
RELATIONSHIP OF DERANGEMENTS IN VARIOUS BLOOD INDICES AND COAGULOPATHY WITH LIVER STIFFNESS INDEX (LSI) IN VARIOUS STAGES OF FIBROSIS IN HEPATITIS C

Azhar Hussain (3rd Year MBBS), Usama Ahmad Yousuf (3rd Year MBBS), Junaid Mushtaq

BACKGROUND: Liver performs a lot of functions and a damage to hepatocytes leads to dysfunction; multiple chemicals are released from it due to structural cell damage like ALT, AST and many others and cause functional loss leading to changes in albumin, bilirubin and clotting factors.

AIM: To determine the relationship of derangements in various blood indices and coagulopathy With Liver Stiffness Index (LSI) In various stages of fibrosis in Hepatitis-C

METHODS: The prospective cross-sectional study was conducted in medicine wards and hepatitis clinic of LGH/AMC, Lahore from February 22, 2018 to January 21, 2019. We studied 251 HCV infected patients and got CBC, LFTs, ELISA and PCR done to diagnose ongoing hepatitis C infection and then, fibro scan were performed for staging of fibrosis. In order to differentiate HCV fibrosis progression, we compared the relationship of derangements in various blood indices and coagulopathy with liver stiffness index (LSI) in various stages of fibrosis in hepatitis C.

RESULTS: The independent t-test result of variables like patient age, baseline viral load, TLC, neutrophil count, platelet count, MCV, MCH, MCHC, Hb, Hct, ALT, AST, ALP, albumin, PT, APTT for fibrosis stages F0–1 and F2 have statistically significant result with fibro scan score or liver stiffness index with p values < 0.05 except TLC, Neutrophil Count, Platelet Count, MCV, MCH, MCHC, Hct, ALT, AST, ALP, albumin, PT, APTT; while for F3 and F4, all of these variables found to be significant except TLC, MCV, MCH, MCHC and Hct. They were able correlate to stage of liver fibrosis with correlation coefficient indexes or R squared values of 0.827,0.822, 0.798, 0.902, 0.878, 0.735, 0.981, 0.952, 0.86 and 0.846 respectively.

CONCLUSIONS: Various blood indices (TLC, Neutrophil Count, Platelet Count, MCV, MCH, MCHC, Hb and Hct) and coagulopathy (prolonged PT and aPTT) showed a positive association with liver stiffness index (LSI) in various stages of fibrosis in hepatitis C.

KEYWORDS: Blood Indices, Coagulopathy, Liver Stiffness Index (LSI)

Relationship of derangements in various blood indices and coagulopathy with liver stiffness index (lsi) in various stages of fibrosis in hepatitis c
3 Azhar Hussain
RELATIONSHIP OF MICROCYTIC HYPOCHROMIC AND NORMOCYTIC HYPOCHROMIC ANEMIA WITH LIVER STIFFNESS INDEX IN HEPATITIS C PATIENTS.

Azhar Hussain (\3rd Year MBBS), Usama Ahmad Yousuf (Year MBBS), Junaid Mushtaq, Bilal Nasir, Ghias ul Hassan, Israr Ul Haque Toor, Ghias Un Nabi Tayyab, Muhammad Asif Gull, Gastroenterology Department, Lahore General Hospital, Lahore

BACKGROUND: Chronic hepatitis disease is frequently associated with anemias among the complications. We tried to find out co relation between Liver stiffness index (LSI) and probability to have microcytic and normocytic hypochromic anemias in hepatitis C patients.

AIMS: To find out co-relation between Liver stiffness index (LSI) and probability to have microcytic and normocytic hypochromic anemias in hepatitis C patients.

METHODS: It is retrospective cross-sectional study, conducted at hepatitis clinic, LGH. Total 177 patients having HCV, confirmed by PCR, were taken. LFTs were performed, patients having any indication of blood pathologies were excluded from our study. Spearman’s rank correlation was used to determine significant co-relation with continuous variables and Liver fibrosis stages.

RESULTS: Chi square test and T-test for different variables i-e Baseline viral load, Hb, Hematocrit, MCV, MCH, MCHC showed statistically significant relationship (p<0.05) with fibroscan score i-e increased in later stages of fibrosis

CONCLUSION: The probability of both microcytic and normocytic hypochromic anemias increases in F3 and F4 stages and prevention therapy is recommended.

KEYWORDS: Liver stiffness index (LSI), microcytic and normocytic hypochromic anemias, hepatitis C.

Relationship of microcytic hypochromic and normocytic hypochromic anemia with liver stiffness index in hepatitis c patients
4 Mlobhammad .Asim Baig
CEREBRAL PHAEOHYPHOMYCOSIS DUE TO RHINOCLADIELLA IN LIVING DONOR LIVER TRANSPLANT RECIPIENT: CASE REPORT

Baig M.A, Dogar AW. Zehri Shams, Abbas Hasnain ali

INTRODUCTION: Rhinocladiella Mackenziei , a melanized neurotropic fungus, is one of the causative agent for Cerebral Phaeohyphomycosis, resulting in grave with a high mortality rate. Only few cases are reported in Living Donor Liver Transplant (LDLT) Recipient,

AIM: we report a case of cerebral phaeohyphomycosis due to rhinocladiella in living donor liver transplant recipient.

MATERIALS AND MEHTODS: Our patient underwent LDLT seven months back , indication for liver transplant was HBV with HCC within Milan criteria, (alfa fetoprotein 27), His postoperative and ICU course was unremarkable, he was regular and compliant in follow up, Presented 3 months back with short history of persistent fever, Headache, vomiting, features of raised intracranial pressure with no focal deficit or seizures, CT scan brain showed ring enhancing lesion at parietal occipital area, followed by MRI which showed similar findings ,underwent first Craniotomy and evacuation, fungal smear showed moderate septate hypae, Culture grew Rhiocladiella Mackenziei, started on oral Voriconazole and immunosuppression adjusted, His fever, headache partially improved, repeat MRI after one month showed persistent non resolution of brain findings , Second Craniotomy and evacuation performed , repeat culture showed similar organism, Voriconazol continued, His liver function test remained stable for last 3 months,

RESULT: After 2 months of voriconazole and 2 surgeries he is doing much better, Last MRI showed resolution of brain lesions and marked symptomatic improvement.

CONCLUSION: Rhinocladiella Mackenziei is a highly virulent agent and should be considered in differential diagnosis of central nervous system disease in Living Donor Liver Transplant Recipients.

KEY WORDS: LDLT, Fungal infection, Voriconazole

CEREBRAL PHAEOHYPHOMYCOSIS DUE TO RHINOCLADIELLA IN LIVING DONOR LIVER TRANSPLANT RECIPIENT: CASE REPORT
Cerebral phaeohyphomycosis due to rhinocladiella in living donor liver transplant recipient: case report
5 Nasib Zaman
THE INCIDENCE OF HCV INFECTION IN MEDICAL AND MUNICIPAL GARBAGE PICKERS OF MALAKAND DIVISION AND DISTRICT BAJAUR

Nasib Zaman, Iqbal Hussain, Shahid Ali, Zakirullah, Fazal Akbar, Mohammad Ali Centre
for Biotechnology & Microbiology, University of Swat, KPK, Pakistan

BACKGROUND: Chronic Hepatitis C Virus (HCV) is among the major health problems worldwide, especially in developing countries. Medical municipal waste pickers are at higher risk of exposure to infectious viral diseases.

OBJECTIVES: The objective of the current study was to investigate the incidence of HCV infection and associated risks among the medical municipal waste collectors of Malakand Divisions and Bajaur District (Old Tribal Area).

METHODS: During the study period (May-December 2017), blood samples were collected from 300 waste handlers and tested for anti HCV antibodies by using ICT method. The results obtained from data were analyzed statistically with the help SPSS 16 version.

RESULTS: In this study we included 300 males with age ranging from 9 to 76 years means 27.31±11.9 years. Prevalence of HCV was 3.3 % (10/300). Among the positive cases, the rate of HCV positive was slightly higher in married persons than unmarried (4.7% vs. 1.0 %, PV > 0.05, odds ratio 4.73, 95 % =.583-37.3). High rate of infection was found in collectors from District Swat, followed by those in Bajaur District.

CONCLUSION: Needle prick injuries and bare handed practices were the major risk contributing factors for spread of HCV infectious. Most of the workers had no idea about the transmission of HCV during collection of municipal waste.

KEY WORDS: Hepatitis C Virus, waste pickers, incidence, risk factor

The incidence of hcv infection in medical and municipal garbage pickers of malakand division and district bajaur
6 Hasmik Ghazinyan
ELEVATED LIVER ENZYMES IN PATIENTS WITH ACUTE PANCREATITIS

Hasmik Ghazinyan1, Lusine Navoyan²
1Department of Hepatology, Nork Clinical Infection Hospital
²Yerevan State Medical University

BACKGROUND: Worldwide the incidence of acute pancreatitis ranges from 4.9-73.4 cases per 100,000. Pancreatitis has a range of possible causes including gallstones, alcohol abuse, some medications, several viral and bacterial infection, injury of the abdomen, hyperlipidemia, hypercalcemia, idiopathic (cause is unknown in 10-15%). The range of disease is from self-limiting to fatal, with an incidence and mortality rate that increases with age. The most common predisposing cause of pancreatitis during pregnancy is cholelithiasis (i.e., gallstones), due to increased levels of lipids and lipoprotein (including triglycerides) and decreased gallbladder motility. Gallstones are associated with development of acute pancreatitis in 40% of causes.

CASE REPORT: The patient was 25-years-old female, with gestational age of 28 weeks. She was hospitalized with epigastric pain that had radiated to back and accompanied by occasional vomiting. Laboratory findings: leukocytosis 10.8cells/L with 86,2% neutrophils, ALT, AST , amylase were moderately elevated (125U/L, 101,4 U/L, 203U/L, respectively), and slight elevation of alkaline phosphatase, total bilirubin with prevalence of direct (169,8 U/L, 32mg/dl, 28,4 mg/dl, respectively|). Abdominal ultrasound indicated gallstones. On the 3th day of hospitalization she was considered eligible for cesarean section due to increased enzymes of liver and pancreas. The women delivered premature infant by cesarian section. The patient made a full recovery after delivery and IV hydratation, IV antibiotics and symptomatic treatment.

CONCLUSIONS: We have presented a case of elevated liver enzymes complicated by acute pancreatitis. It may be important to monitor indicators of liver function in patients with clinical pancreatitis due to gall bladder stones in pregnancy.

Elevated liver enzymes in patients with acute pancreatitis
7 Junaid Mushtaq
LOW PREVALENCE OF HEPATITIS C IN YOUNG MOTORWAY POLICE OFFICERS PAKISTANI POPULATION - RESULTS OF A HEPATITIS C AND B SCREENING CAMP IN SHEIKUPURA

Junaid Mushtaq, Mukaram Bajwa, Muhammad Bilal , Israr Ul Haque, Prof Ghias Un Nabi

BACKGROUND: Chronic viral hepatitis C and B infection has more prevalence in developing countries with low to limited national per capita income. According to WHO report 2017, Egypt has highest prevalence and Pakistan has the second highest Prevalence of hepatitis C.

AIM: The aim of our study was to find out prevalence of hepatitis C and B, provide awareness among community among young police officers in Punjab, Pakistan.

METHODS: 600 people were screened for hepatitis C as well as for hepatitis B by performing a blood sample via screening method

RESULTS: We have screened 600 motorway Police workers of sheikupura camp facility. 398 (59.2%) were female, 202 (40.7%) were male. 93.1% were married and 6.9% were unmarried. The number of laborers was 56.2%, housewives were 37.9% and government employed working ladies were 6%. On screening through kit method for both hepatitis C and B infection. A total of only 6 (1%) were positive for hepatitis C infection and none of them was positive for hepatitis B infection. Of these 6 positive cases of hepatitis C, only 2 were having new infection which were considered to have new infection and other 4 were treated previously with directly antiviral agents and no data of their SVR was available so they were referred further to a tertiary care facility with proper counseling and work up later on. Interesting to see the results that none them who was positive for hepatitis B infection, so they were administered with the first dose of Hepatitis B vaccination on site and counseled for remaining doses along with this, they were also provided the education regarding the need for testing of there family members and vaccination of hepatitis B if negative and previously not vaccinated.

CONCLUSION: Regardless of higher prevalence as indicated by most of other researchers, the prevalence of hepatitis C has decreased to its minimum of only 1 % after the use of effective antivirals and increased disease awareness among community. So, continuous effort regarding eliminating hepatitis from the local population with effective treatment facilities and

KEYWORDS: Hepatitis C, Hepatitis B, Prevalence, Awareness.

Low prevalence of Hepatitis C in young motorway police officers Pakistani population - results of A Hepatitis C And B screening camp in Sheikupura
8 Junaid Mushtaq
SPECTRUM OF ENDOSCOPIC DYSPHAGIA

Junaid Mushtaq, Ali Abass, Israr ul Haque Toor, Bilal Nasir, Heba khan, Ghias un Nabi Tayyab

INTRODUCTION: A number of disorders, both benign and malignant, interfere with the swallowing process and can cause sensation of dysphagia. Dysphagia is an important alarm symptom; however, the epidemiology remains poorly defined. Prevalence of dysphagia are rare; previous studies suggest that the prevalence of dysphagia is between 16% and 22%.

AIM: To determine the spectrum of causes of dysphagia by endoscopy.

MATERIALS AND METHODS: A cross-sectional descriptive study was carried out in the city of Lahore at Division of Gastroenterology, Lahore General Hospital, a public-sector health care facility during January 2015 to December 2016. The sample size was drawn by non-probability, convenience sampling from the consecutive reported patients.

A total of 157 Consecutive patients with dysphagia were included in the study and their data include brief history of dysphagia , demography , weight loss , and endoscopic findings which was then analyzed on SPSS 20. An institutional review committee clearance was obtained by Lahore General Hospital, a written consent form was signed by the study participants.

RESULTS: A total of 157 patients presenting with dysphagia were studied, 86 (54.8%) males and 71 (45.2%) females and the mean age was 49.76 ± 18.24. Study participants were divided into two categories progressive dysphagia and intermittent dysphagia based on the histories obtained. Progressive dysphagia (TABLE 1) seen in 105 (66.88%) patients while Intermittent dysphagia (TALBE 2) seen in 52 (33.12%). Esophageal Mass was commonest finding noted in 30 (28.57%) patients presenting with progressive dysphagia and significant weight loss, followed by Barret’s, Esophageal web and peptic stricture in 12 (11.42%) patients each followed by external compression in 4 ( 0.04%) and Eosinophilic esophagitis in 3 (0.03%) patients. While, Achalasia was commonest finding in 18 (34.61%) patients with intermittent dysphagia and no significant weight loss followed by normal in 8 (15.38%) patients and 5 (0.10%) patients of hiatus hernia.

CONCLUSION: Dysphagia is an alarming symptom and must be evaluated promptly. Although, in our study there were cases having normal findings (10.8%) on endoscopic evaluation but more than half of the cases were due to premalignant conditions and timely assessment is a major factor to avoid grave prognosis. Gastro-esophageal endoscopy, in cases of dysphagia, is of prime importance.

Progressive Dysphagia Intermittent Dysphagia
Esophageal Mass 33.12 % Achalasia 34.61 %
Barrett’s esophagus 11.42 % Normal 15.38 %
Esophageal Web 11.42 % Esophageal Mass 13.46 %
Peptic Stricture 11.42 % Hiatus Hernia 9.61 %
Achalasia 7.61 % Esophageal Web 7.69 %
Normal 7.61 % Peptic Stricture 5.77 %
Foreign Body 3.92 % Esophageal diverticula 5.77 %
External compression 3.92 % Barrett’s esophagus 3.84 %
Esophageal Ring 3.92 % Esophageal Ring 1.92 %
Eosinophilic esophagitis 2.94 % Eosinophilic esophagitis 1.92 %
Spectrum of endoscopic dysphagia
9 Hanisha Khemani
RISK FACTORS OF HEPATITIS B IN CHILDREN

Hanisha Khemani

INTRODUCTION: Hepatitis B is a viral infection that attacks the liver causing inflammatory changes. The infection is most commonly transmitted by vertical transmission, through contact with blood or other bodily fluids.

AIM: We evaluated the frequency of risk factors of Hepatitis B virus in children presenting to a tertiary care hospital of Pakistan.

METHODOLOGY: This descriptive cross-sectional study was conducted at the Gastroenterology section of Medical Unit IV, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. After obtaining ethical approval and informed consent from the guardians, children between the ages of 2 to 15 years, diagnosed with Hepatitis B virus were included in the study. Patients with positive Hepatitis B Surface Antigen were included in the study. Patient’s current HBV status, history of blood transfusion and history of surgery or dental procedures were recorded in pre-designed Pro-forma. Data were analyzed using SPSS version 25. We desire a larger sample size so this study is continued further.

RESULTS: A total of 47 patients were enrolled in this data collection out of which 34 (72.3%) were male while 13 (27.7%) were female. Mean age of patients was 12.0 ± 2.3 years. Out of these, 9 (19.1%) had chronic HBV infection while 14 (29.8%) patients had an inactive infection. Five (10.6%) patients had a perinatal route of transmission and only one (2.1%) patient had a positive past surgical history. Thirty-four (72.3%) patients had a positive family history.

CONCLUSION: Mass awareness campaigns are needed in order to educate the general population regarding Hepatitis B Virus Infection. Maternal infection is a serious threat to the unborn child. Hepatitis B vaccine should be administered to all newborns regardless of maternal HBsAg status. Data collection is still ongoing.

Risk factors of Hepatitis B in children
10 Hanisha Khemani
FULMINANT HEPATIC FAILURE ETIOLOGY, CLINICAL MANIFESTATIONS, AND OUTCOME: AN EXPERIENCE OF TERTIARY CARE HOSPITAL OF KARACHI, PAKISTAN.

Hanisha Khemani

INTRODUCTION: Fulminant hepatic failure (FHF), a term given to the acute liver injury causing sudden deterioration of hepatic function and encephalopathy within eight weeks of appearance of first symptom in a patient having no prior liver disease. It may be caused by toxins, drugs, viruses, or metabolic diseases, with viral hepatitis being the cause in 40-60% cases. In Pakistan, all types of hepatitis viruses are endemic, raising the prevalence up to 70-80%. This study is an attempt to present all the clinical features of FHF in patients presenting to a tertiary care hospital of Pakistan and the management given to improve the high mortality rate of this condition.

AIM: To Determine The Etiology, Clinical Manifestations, And Outcome In Fulminant Hepatic Failure

MATERIALS AND METHODOLOGY: This prospective observational study was conducted at the Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan from 2019 to 2019. Patients with clinical and biochemical diagnosis of FHF were registered and followed with adequate management for seeing the outcome.

RESULTS: During the study period, 40 patients were enrolled, of which 25 (62.5%) were males and 15 (37.5%) were females with a mean age of 26.03±9.95 years. Among the females, 12 were pregnant. Hepatitis E was found as the most common cause of FHF with negative serology in 19 patients (47.5%). Patients were treated conservatively and around 31 (77.5%) of patients were shifted to Intensive care unit. 35 (87.5%) of patients died by the end of study period while five patients recovered and were discharged symptom free.

CONCLUSION: The mortality rate of FHF is very high especially in developing countries just like we observed, and this might be due to late referrals causing inadequate treatment owing to lack of timely diagnosis.

Fulminant Hepatic Failure etiology, clinical manifestations, and outcome: an experience of tertiary care hospital Of Karachi, Pakistan.
11 Nazish Butt
EFFICACY & SAFETY OF SOFOSBUVIR-VELPATASVIR COMBINATION IN HCV INFECTED PAKISTANI PATIENTS WITHOUT CIRRHOSIS OR WITH COMPENSATED CIRRHOSIS, A PROSPECTIVE OPEN LABEL INTERVENTIONAL TRIAL.

Nazish Butt a, Talha Qureshi a, Muhammad Iltaf b, Zaheer Akhtar c, Atique Abu Bakr d, Ali Mashhood e, Sharib Syed Muhammad f, Neeta Maheshwary f.

a) Department of Gastroenterology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
b) Department of Gastroenterology, Hayatabad Medical Complex, Peshawar, Pakistan.
c) Department of Gastroenterology, Gulab Devi Hospital, Lahore, Pakistan.
d) Department of Gastroenterology, Jinnah Hospital Lahore, Pakistan.
e) Department of Gastroenterology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
f) Medical Affairs Department, Hilton Pharma Pvt Ltd, Karachi, Pakistan.

BACKGROUND: Currently in Pakistan there is paucity of published clinical data regarding efficacy of Sofosbuvir-Velpatasvir in the management of patients with Hepatitis-C without cirrhosis or with compensated Cirrhosis.

AIM: of the study was to determine efficacy and safety of the approved DAA therapy SOF-VEL in patients infected with HCV without cirrhosis & with compensated cirrhosis.

METHODS: A prospective open label, multicenter, interventional trial was conducted in patients with Hepatitis-C without cirrhosis or with compensated cirrhosis (Child Turcotte Pugh class A). Patients having hepatitis-C without cirrhosis or with compensated cirrhosis were screened and 133 patients were enrolled in the study who received Sofosbuvir 400 mg + Velpatasvir 100 mg combination once daily, for 12 weeks. Patients were followed for six months after the start of therapy. HCV viral load was assessed at baseline, week 12 and after 24 weeks after start of treatment.

RESULTS: Among 133 enrolled patients 79 were male while 54 were female. Ninety five (71.4%) among enrolled patients were without cirrhosis and 38 patients had compensated cirrhosis. Patients without cirrhosis had mean age of 45.90 ± 10.99 years, while compensated cirrhotic patients had mean age of 52.60 ± 12.29 years. As per intention to treat analysis all non-cirrhotic patients and 35 (92.1%) compensated cirrhotic patients achieved undetectable viral load (HCV RNA < 15 IU/mL) at 12th week of the start of treatment. 86 (90.5%) non-cirrhotic patients achieved sustained virologic response (SVR) 12 weeks after the end of therapy. Patients with compensated cirrhosis, experienced more adverse events (31.5%) than non-cirrhotic patients (20.15%).

CONCLUSION: Direct acting antiviral therapy using sofosbuvir and velpatasvir combination is efficacious and safe in patients with HCV non-cirrhotic and compensated cirrhosis.

REGISTRATION OF CLINICAL TRIAL: This trial is registered in WHO, International Clinical Trial Registry Platform, through Iranian Registry of Clinical Trials (IRCT) having IRCT ID: IRCT20170614034526N4, registered prospectively on 2019-03-28.

KEY WORDS: Hepatitis C, compensated cirrhosis, Sofosbuvir-velpatasvir.

Efficacy & safety of sofosbuvir-velpatasvir combination in hcv infected pakistani patients without cirrhosis or with compensated cirrhosis, a prospective open label interventional trial
12 Saleha Bibi
COMPARATIVE STUDY OF PERSONALITY TRAITS AMONG PATIENTS OF LIVER, CARDIAC AND KIDNEY DISEASES

Saleha Bibi, Irsa Rehman
Army Special Education Academy, Fort Road Rawalpindi

AIM: Current study was conducted to investigate the differences in personality traits among Patients of liver, cardiac and kidney diseases.

MATERIAL AND METHOD: Convenient sampling technique was used to collect the sample of 300 participants including 100 liver patients, 100 cardiac and 100 kidney patients. Study was conducted at hospitals of Rawalpindi and Islamabad. Age categories were formed according to the WHO classification of age across life span. Urdu version of big five inventory was used to assess personality traits of participants.

RESULTS: Data was statistically analysed by using SPSS. Results of our study showed that liver patients scored statistically significantly high on neuroticism mean 36.2, SD 12.3 while cardiac patients scored significantly high on extraversion and conscientiousness mean 42.1, SD 15.2. Our study also revealed that kidney patients have high level of agreeableness and openness to experience mean 48.4, SD 20.1. In addition our study suggested that education was positively related with extraversion (r=.23*), conscientiousness (r=.31**) and openness (r=.21*) while level of education was negatively related with agreeableness (r=-.34**) and neuroticism (r=-.21*). Our study also revealed significant gender differences on personality traits. Women patients were found to be more neurotic and scored significantly high on agreeableness mean 44.1, SD 10.1 and openness mean 34.4, SD 7.2, whereas male patients score significantly high on conscientiousness mean 45.3, SD 15.1 and extraversion mean 50.4, SD 24.3 p value was 0.001

CONCLUSION: Our study has clinical and community implication and serves as baseline study for further researches investigating age related differences on personality traits. Our study revealed that personality of a person differ according to disease. So we found that nature of the disease can also predicts personality type of a person.

KEYWORDS: Personality traits; Liver; Cardiac; Kidney Patients

Comparative study of personality traits among patients of liver, cardiac and kidney diseases
13 Lajpat Rai
ASSESSMENT OF LIVER FIBROSIS WITH TRANSIENT ELASTOGRAPHY IN NAFLD PATIENTS

Nazish Butt, Amanullah Abbasi, Lajpat Rai, Riaz Hussain, Hanisha Khemani, Riaz Hussain, Ali Khan, Sabir Ali.
Jinnah Postgraduate Medical Centre, Karachi.

INTRODUCTION: Transient Elastography (TE) is a non‐invasive technique for estimating liver fibrosis. Having said that, there are still limited data about the performance of TE in Pakistani patients with non‐alcoholic fatty liver disease (NAFLD). NAFLD is a global outbreak, it is pivotal that patients with NAFLD should undergo an assessment for their risk of advanced fibrosis, which enhances the risk of hepatocellular carcinoma (HCC) and other complications of cirrhosis. An overall prevalence of NAFLD in Pakistan is 47%.

AIM: In the present study, we have evaluated the diagnostic accuracy of TE in identifying different degrees of fibrosis in NAFLD adult patients

METHODOLOGY: A Cross-sectional study was undertaken at the Department of Gastroenterology, Jinnah Postgraduate Medical Centre and Medical Unit II, Dow University of Health Sciences Ojha campus Karachi, Pakistan. After obtaining ethical approval, all patients above the age of 18 years, with diagnosis of NAFLD on the basis of abnormal liver function tests (LFTs) and on ultrasound abdomen consistent with fatty liver were included in the study. All patients with hepatitis, hepatic malignancies, hepatobiliary infections, and biliary tract disease were excluded from the study. Fibrosis score was calculated through Elastography as: F0-F1 (5.3-7.1 kPa, Normal); F2 (7.5-8.5 kPa, Mild/Grade-I); F3 (9.5-13.0 kPa, Moderate/Grade-II); and F4 (13.1-18.8 kPa, Severe/Grade-III). This study is an ongoing study.

RESULTS: A total of 162 patients were enrolled in the study, from which 41 (25%) were male and 121 (75%) were female, with a mean age of 39.60 ± 9.74 years. Out of these, 108 (67%) belonged to the lower socioeconomic class. 121 (75%) patients had fatty liver on ultrasound while 41 (16%) had hepatomegaly with fatty changes. 64 (40%) patients had a liver elastography score of F0-F1, 61 (38%) had a score of F2, 28 (17%) had a score of F3, while only 9 (6%) had a score of F4.

CONCLUSION: The detection of liver fibrosis at early stages is crucial in preventing its progression to cirrhosis which is the irreversible fibrotic changes in the liver tissue. Reversal of fibrosis is only possible if it is diagnosed as early as possible and managed with appropriate treatment.

Assessment Of Liver Fibrosis With Transient Elastography In Nafld Patients
14 Lajpat Rai
LONG-TERM RENAL AND BONE SAFETY OF TENOFOVIR DISOPROXIL FUMARATE IN CHRONIC HEPATITIS B PATIENTS WITH CIRRHOSIS

Lajpat Rai.

INTRODUCTION: Tenofovir disoproxil fumarate (TDF), prodrug of the nucleotide analog reverse transcriptase inhibitor Tenofovir, is one of the approved drugs for chronic hepatitis B (CHB) management. Although not curative, it inhibits viral replication, requiring long-term administration. It is generally considered safe but there is a strong risk of loss of bone mineral density and renal function which is why it is being replaced by newer formulations like Tenofovir alafenamide.

AIM: Here, we aimed to evaluate the renal and bone safety profile of TDF in CHB patients with cirrhosis.

MATERIALS AND METHODOLOGY: This prospective interventional study was conducted at the Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan from January 2019 till date. A total of 120 patients with CHB started on TDF therapy were registered of which 84 had normal Dual-Energy X-ray Absorptiometry (DEXA) scan and estimated glomerular filtration rate (eGFR) on presentation, rest were excluded. All the enrolled patients were negative for hepatitis C, D, Human immunodeficiency virus, renal, or bone disorder. After six months of TDF administration, patients underwent a DEXA scan of the left hip and lumbar spine and eGFR measurement for checking bone and renal changes respectively. According to the World health organization, a T-score of ≥1 indicates a normal BMD, a T-score of −1 to −2.5 indicates osteopenia, and a T-score of −2.5 or less indicates osteoporosis. eGFR was considered normal when it was >90 ml/min/1.73m2.

RESULTS: Out of the study population of 84, 51 (60.7%) were males and 33 (39.3%) were females, with a mean age of 32.50±12.01 years. Osteopenia was recorded in 23 patients (27.4%) at the lumbar site and 23 (27.4%) at the hip. Osteoporosis was found in 10 patients (11.9%) at the lumbar site and 4 (4.8%) at the hip site. When eGFR was evaluated, 21 patients (25.0%) had their eGFR reduced.

CONCLUSION: The results of this study conclude that the use of TDF is associated with reductions in renal function in patients with CHB having no prior renal or bone disease.

Baseline characteristics of Patients with Chronic Hepatitis B
Mean Age (in years) 32.50±12.01 years
Gender
Male
Female
 
51 (60.7%)
33 (39.3%)
Marital Status
Single
Married
 
19 (22.6%)
65 (77.4%)
Ethnicity
Urdu
Sindhi
Balochi
Pathan
Punjabi
 
36 (2.9%)
25 (29.8%)
8 (9.5%)
9 (10.7%)
6 (7.1%)
SES
Lower SES
Middle SES
 
56 (66.7%)
28 (33.3%)
Comorbidity
None
HTN
DM
 
69 (82.1%)
6 (7.1%)
8 (9.5%)
Mean lumbar spine T-score -0.38 ± 1.66
Mean lumbar spine Z-score -0.36 ± 1.33
Mean Left hip T-score -0.06 ± 1.29
Mean Left hip Z-score -0.06 ± 1.02
Mean eGFR 123.38 ± 58.89
Long-term renal and bone safety of tenofovir disoproxil fumarate in chronic Hepatitis B patients with cirrhosis
15 Shahid Rasool
DE NOVO HEPATOCELLULAR CARCINOMA AFTER DIRECT ACTING ANTIVIRAL THERAPY FOR CHRONIC HEPATITIS C: A STUDY FROM SOUTH ASIAN COUNTRY

Shahid Rasool , Sofia Hanif , Ahmad Nawaz, Hafiz Muhammad Shahid
Department of Gastroenterology, Madina Teaching Hospital, Faisalabad

BACKGROUND: The recent introduction of new antiviral drugs allowed achieving SVR rates in over 90% of patients. Possibility of developing De novo HCC after exposure to these new antivirals is one of the major concerns among patients and physicians. The studies conducted previously on this topic were generally small and of varying quality, leaving clinicians in a state of uncertainty.

OBJECTIVE: To determine the frequency of newly diagnosed cases of HCC after completion of direct acting antiviral therapy in patients with Chronic hepatitis C.(CHC)

MATERIALS AND METHODS: This hospital based Quasi interventional study was conducted from May 2017 to September 2018. A total of 90 patients with CHC, who had completed Antiviral Therapy at least 6 months ago were enrolled. All patients were followed for minimum of 1 year. Patients were followed with USG and AFP 3 monthly, Triphasic CT was performed only if there was suspicion of HCC. Data was presented as mean+/- SD , frequency & percentages.

RESULTS: A total of 90 patients were enrolled, 65.6% were females and 34.4% were males. 70% patients were non cirrhotic, 21.1% compensated cirrhotic and 8.9% were decompensated cirrhotic. SVR was achieved in 96.7%. During the follow up period, 5 (5.6%) patients developed de novo HCC, 3 were in the compensated group, 2 in the decompensated group and none in the non-cirrhotic group.

CONCLUSION: Data from our study shows that, few patients developed de novo HCC (5.6%) in the cirrhotic group after DAA exposure. To establish the above said association, for sure we need to study with larger sample size and longer follow up.

KEYWORDS: Direct Acting Antiviral Agents, Hepatocellular Carcinoma , Sustained Virological Response.

De novo Hepatocellular Carcinoma after direct acting antiviral therapy for chronic Hepatitis C: a study from South Asian country
16 Sofia Shahid
NON-INVASIVE SCREENING OF ESOPHAGEAL VARICES IN PATIENTS WITH LIVER CIRRHOSIS

Sofia Shahid, Shahid Rasool, Ahmad Nawaz, Javeria Komal ,Hafiz Muhammad Shahid
Department of Gastroenterology, Madina Teaching Hospital, Faisalabad

BACKGROUND: The recommended method for identifying the presence of varices in cirrhotic is esophagogastroduodenoscopy (EGD). The disadvantages of EGD include the complications associated with endoscopy, especially the need for intravenous sedation and cost. There are many non-invasive markers proposed for detecting esophageal varices with varying degree of success.

AIM: To determine the diagnostic performance of non-invasive scoring systems in predicting the presence of varices in patients with liver cirrhosis by using endoscopy as the standard reference.

PATIENTS & METHODS: In this analytical cross sectional study we had 110 patients with liver cirrhosis without a history of variceal bleeding. Demographic, clinical, biochemical and ultrasonographic parameters were recorded. We used selected non-invasive parameters such as, AST to platelet ratio index (APRI), platelet count to spleen diameter (PC/SD), fibrosis-4-index (FIB-4), Bonacini score and King’s Score. Esophageal varices were confirmed by endoscopy.

RESULTS: The study population had mean age of 43 ± 9 years. On evaluation of the studied non-invasive parameter in predicting EV it was noted that FIB-4 was significant (sensitivity of 86%, specificity 64%) with cutoff of 3.15, Bonacini score was significant (sensitivity 81%, specificity 61%) with a cutoff of 6, PC/SD was significant (sensitivity of 80%, specificity 57%) with a cutoff of 884.3 and king score was significant (sensitivity of 76%, specificity 54%) with a cutoff of 36.7. By multivariate regression analysis of the significant parameters, we reported that FIB-4 was the most significant parameter followed by Bonacini score, PC/SD and king score respectively.

CONCLUSION: Non-invasive methods have provided alternatives for screening EGD in cirrhotic patients. However, this is an area that could still benefit from further research.

KEY WORDS: Esophageal Varices, fibrosis-4-index, Bonacini score, King’s Score.

Non-invasive screening of esophageal varices in patients with liver cirrhosis
17 Talal khurshid
ASSESSMENT OF SEVERITY OF ACUTE LIVER INJURY AND ITS OUTCOME IN PATIENTS WITH DENGUE FEVER IN LAHORE AND RAWALPINDI.

Talal khurshid*, Mashood Ali,*Muhammad Umar**, Tayyab Saeed Akhtar,**,Madeha Irfan**
* Department of Gastroenterology, PIMS Islamabad.
**Department of Medicine, Holy Family Hospital / Rawalpindi Medical College, Rawalpindi.

AIM: To evaluate the impact of Dengue Virus infections on liver by measuring aminotransferase levels of the patients suffering from DF during epidemic in Lahore in 2011 and in Rawalpindi in 2015.

MATERIAL AND METHODS: It is a multi-centered retrospective analysis of 1700 patients (1000 from LGH Lahore and 700 from HFH, Rawalpindi in 2011 & 2015 respectively. Data was analyzed in SPSS 19 with 16 variables on which relevant details were noted.

Degree of Liver Damage: The degree to which the liver was affected was evaluated in these patients and classified into four groups according to AST and ALT levels (The laboratory reference values of AST & ALT for males and females were 28 & 26 IU and 30 & 29IU/L, respectively) at the time of presentation.

  • Group A: Patients with normal AST and ALT levels.
  • Group B: Patients with one of the aminotransferases increased but not > UNL X 3.
  • Group C: Patients with transaminitis of 3-10 X reference values.
  • Group D: Patients with transaminitis >10 X reference values.

RESULTS: The patients were classified in to classical DF, DHF and DSS (77.6%, 20.6% and 1.8 % respectively. The degree of rise in aminotransferases indicating liver injury observed in LGH, Lahore was 34.9% (Grade A), 48.5% (Grade B), 14.8% (Grade C) and 1.8% (Grade D). However, in BBH, Rawalpindi, it was observed as 43.8% (Grade A), 49.3% (Grade B), 6.6% (Grade C) and 0.3% (Grade D). In classic DF patients, (5% vs 2.8%) were having grade C & D liver damage and (95% vs 97.2%) have no significant liver injury in LGH and HFH respectively. In DHF, aminotransferases were high in (83.2% vs 68.6%) of which (71.3% vs 54.8% patients have Grade C and (31.8% vs 17.3%) have Grade D Liver injury. In patients with DSS, (10% vs 3.1%) have Grade C and 90% vs 83.2%) with Grade D (Highest mortality and long term morbidity) in LGH and HFH respectively.

CONCLUSIONS: In Dengue outbreaks in Lahore (2011) and Rawalpindi (2015), majority of patients suffered from DF and a rise in liver enzymes was observed in majority of patients though a significant rise of liver enzymes (Grade D) was observed in patients suffering from DHS and DSS patients only. However, there is significant rise in liver enzymes in 2011 epidemic as compared to 2015 in comparative analysis of two Divisions of Punjab.

Assessment of severity of acute liver injury and its outcome in patients with dengue fever in Lahore And Rawalpindi
18 Talal khurshid
DYSPEPSIA IN CIRRHOTIC HEPATITIS C PATIENTS

Talal Khurshid, Muhammad Umar, Mashhood Ali
Corresponding author; talalkhurshid@gmail.com. Resident GI PIMS

AIM: To determine the frequency of patients with dyspepsia, its patterns of presentation and causes along with their associations with gender and age, amongst HCV cirrhotic patients presenting to a tertiary care health facility of Rawalpindi.

METHODS: In this cross sectional study 207 HCV cirrhotic patients above 25 years of age irrespective of gender, were included. Patients receiving prolonged treatment of acid suppression prior to hospitalization were excluded. After taking history and performing thorough physical examination, routine laboratory investigations, abdominal ultrasonography and endoscopies were performed to determine the cause of dyspepsia.

RESULTS: Amongst 207 HCV cirrhotic patients 146 (70.5%) presented with dyspepsia. Pain in epigastrium 92 (63.0%), heart burn 81 (55.5%) and water brash 65 (44.5%) were most common patterns of presentation of dyspepsia in HCV cirrhotic patients. Portal hypertensive gastropathy 77(52.7%) came out as leading etiology of dyspepsia, followed by gastritis 9(6.2%), ulcer 6(4.1%) and cholelithiasis4(2.7%). Amongst those diagnosed with Dyspepsia, 25(17.1%) patients were found to have functional dyspepsia i.e. no organic cause was found.

CONCLUSION: Dyspepsia is very frequent phenomenon in HCV cirrhotic patients with most common patterns of presentation as pain in epigastrium and heart burn. The leading cause of dyspepsia was portal hypertensive gastropathy.

KEY WORDS: Dyspepsia, Hepatitis

Dyspepsia in cirrhotic hepatitis c patients
19 Mohammad Hafeez
HEPATOCELLULAR CARCINOMA (HCC), WHERE DO WE STAND? CURRENT SITUATION

Muhammad Hafeez, Muhammad Nadeem, Mahmood Ahmed, Faheem-ur-Rehman

OBJECTIVE: To identify the stage of Hepatocellular Carcinoma (HCC) at the time of presentation.

METHODS: This cross sectional observational prospective study was carried out at Gastro Department of Combined Military Hospital (CMH) Multan from August 2017 to December 2018. Patients diagnosed on the basis of alpha fetoprotein, abdominal ultrasound, triphasic contrast enhanced Computerized tomography (CECT). They were evaluated for etiology including Hepatitis B, C and non B & C. The patients were inquired about the previous treatment and when they came to know about the HCC. Staging of the tumor was done on the basis BCLC (Barcelona cancer liver clinic) and Melan’s criteria. Performance status (PS) of the patient was checked by Eastern Cooperative Oncology Group (ECOG) criteria. Severity of cirrhosis was assessed by CTP (Child Turcotte Pugh) and Model for end stage liver disease (MELD) score. The data was analyzed in IBM SPSS version 22.

RESULTS: Out of 135 patients 78% were males and 22 % females. Age Mean SD was 58.81± 9.366. Frequency of hepatitis C, B, combined B, C and non-B non-C was 80%, 11%, 2.8% and 6.2% respectively. 96(73.8%) never got the treatment before for Hepatitis. 81(62.3%) came to know first time on this index admission. Max numbers of patients were in BCLC stage B i.e. 82(55.2%) with ECOG grade of 1 i.e.57 (39.3%), at the time of presentation. Mean MELD and CTP score were 12.24, 7.34 (class B) respectively.

CONCLUSION: HCV was the most common in HCC, never treated before, presented for the first time in advance stage of the disease where very limited treatment options left behind.

KEYWORDS: Hepatocellular Carcinoma, Staging of HCC, BCLC, MELD.

Hepatocellular carcinoma (HCC), where do we stand? current situation
20 Ansarullah Khan
TEMPORAL TRENDS IN PREVALENCE OF HEPATITIS B AND C AND HUMAN IMMUNODEFICIENCY VIRUS IN BLOOD DONORS OF PAKISTAN

Ansarullah Khan

BACKGROUND: A Transfusion transmitted infection (TTI) is a virus, parasite, or other potential pathogen that can be transmitted in donated blood through a transfusion to a recipient. Hepatitis B, hepatitis C, Human Immuno-Deficiency virus are common examples of TTIs.

AIMS AND OBJECTIVES: The aim of this study was to determine the temporal trends in prevalence of HBV, HCV and HIV in blood donors of Pakistan over the last 14 years

METHODS AND MATERIALS: A retrospective study was carried out in the blood donors who donated their blood at Pakistan Institute of Medical Sciences (PIMS) Islamabad. Blood samples were screened for HBV,HCV and HIV over a period of 14 years from 2005 to 2018. Blood donors were selected according to the WHO criteria for blood donation.

RESULTS: A total of 312320 individuals donated blood between 2005 and 2018 out of which 311476 (99.7%) were males and only 991(0.3%) were females The number of annual blood donations increased from 7829 In 2005 to 30731 in 2018. The total number of donors found positive for HBV,HCV and HIV was 5752, 8951, 124 respectively. Along the study period a slight increase in HBV prevalence of 1.225% in 2005, to 1.451% in 2018 was observed. Meanwhile the prevalence of HCV decreased from 2.25% to1.474%. While an alarming increase was observed in the prevalence of HIV. Its prevalence was 0% in 2005, 0.006% in 2006 and reached 0.065% 2018.

CONCLUSION: The study has shown that HCV is the most prevalent transfusion transmitted infection found in Pakistan blood donors. HIV has the lowest prevalence but has shown the highest increase over the course of last 14 years i.e by a factor of 11. A net decrease was observed in the prevalence of HBV while HCV showed an increased prevalence. The results show that there is a need to take safety measures to control the increasing prevalence of TTIs in the Pakistani population.

TEMPORAL TRENDS IN PREVALENCE OF HEPATITIS B AND C AND HUMAN IMMUNODEFICIENCY VIRUS IN  BLOOD DONORS OF PAKISTAN
Temporal Trends In Prevalence Of Hepatitis B And C And Human Immunodeficiency Virus In Blood Donors Of Pakistan
S. No. Date Author Title of Presentation
1 6th Dec 2019.
1830-2000 hrs
Azhar Hussain
ACCESSING THE SAFETY AND EFFECTIVENESS OF ENDOSCOPIST-DIRECTED NURSE-ADMINISTERED PROPOFOL SEDATION (EDNAPS) IN LOW RISK PATIENTS UNDERGOING ROUTINE GASTROINTESTINAL ENDOSCOPIC PROCEDURES

Azhar Hussain (3rd Year MBBS), Usama Ahmad Yousuf (3rd Year MBBS), Dr. Junaid Mushtaq, Dr. Bilal Nasir, Dr. Ghias ul Hassan, Dr. Israr Ul Haque Toor, Prof. Dr. Ghias Un Nabi Tayyab, Dr. Muhammad Asif Gull.
Gastroenterology Department , Lahore General Hospital Lahore

AIM: The aim of our study is to review the safety and effectiveness of Endoscopist-directed nurse-administered propofol sedation (EDNAPS) during GIT endoscopic procedures, occurrence of major and minor adverse events followed by propofol sedation and level of patient satisfaction and possible choice of propofol as sedative agent in their future endoscopic procedures in Pakistani population.

METHODS: Prospective data was collected from patients receiving diagnostic EGD, colonoscopy or ERCP. Subjects who stopped the emergency procedure, or where both EGD and colonoscopy were performed on the same date were excluded. Other exclusions include under 20 years of age, pregnancy, the American Society of Associate Psychologists (ASA) Class III or IV, overweight (body weight> 100kg), or drugs or its components (Soybean or egg) allergies included.

RESULTS: During the study period, a total of 478 patients underwent outpatient endoscopic procedures with propofol sedation of which 363 (75.9%) had EGD, 87 (18.3%) had colonoscopy and those undergoing ERCP were 28 (5.8%). Mean age was 46.0±15.2 years and a higher proportion of patients i.e. 55.8% were males except for ERCP procedure. Mean propofol dosage was 78.0±31.4, 114.4±49.7 and 153.2±45.8 mg for EGD, Colonoscopy and ERCP respectively. The required examination was completed in all cases. There was no major adverse event. Majority of the patients i.e. 363 (99.4%) rated the procedure satisfactory and agreed to undergo same sedative for next time. Age specific propofol dosage were similar across gender except for age group 60 years and above where higher mean propofol dosage was required for females as compared to males for EGD and Colonoscopy (82.8±32.2 vs. 63.5±29.8; p-value 0.005; 81.1±26.1 vs. 75.3±25.0; p-value 0.03)

CONCLUSIONS: Endoscopist-directed nurse-administered propofol sedation (EDNAPS) during GIT endoscopic procedures is safe and effective in selected patients.

KEYWORDS: Endoscopist-directed nurse-administered propofol sedation (EDNAPS), gastrointestinal endoscopic procedures

Accessing the safety and effectiveness of endoscopist-directed nurse-administered propofol sedation (EDNAPS) in low risk patients undergoing routine gastrointestinal endoscopic procedures
2 6th Dec 2019.
1830-2000 hrs
Abdul Wahab Dogar
SUCCESSFUL JOURNEY OF 100 LIVING DONOR LIVER TRANSPLANT FROM STUMBLING TO INCLINE IN REMOTE AREA OF PAKISTAN; BEGINNING OF NEW ERA.

Dogar Abdul Wahab; Baig Muhammad Asif; Zehri, Shams; Abbas, Syed Hasnain;, Zafar Munazza
Pir Abdul Qadir Shah Jeelani institute of Medical Sciences, GAMBAT

BACKGROUND: End stage liver disease ( ESLD) is an important cause of morbidity and mortality, Living donor liver transplant (LDLT) is matchless choice for ESLD where cadaveric program is a dream.

AIMS: Aim of this study was to comprehend single center outcome of 100 LDLT recipients in GAMBAT small town in remote area of Pakistan and to focus challenges in public sector living donor liver program in a developing country.

METHODS: This is a Single center study in which we retrospectively reviewed patients who underwent living donor liver transplant (LDLT) from April 2016 till November 2019, Patient’s demographics, causes of liver disease, graft, operative variables, complications were assessed, Liver transplant outcome was assessed on the basis of number of days survived and mortality.

RESULT: Median age was 40.5 (9-60) years, whereas median BMI 22.5 (15.5-34.26). The male to female ratio was 9:1. ESLD secondary to hepatitis B and D was the most common indication (55% patients) followed by hepatitis C (28%), other indications HCC within Milan criteria (10%), Primary sclerosing cholangitis, Wilson (2%), PFIC and Bud Chari (1%), Most of the patients belong from Sindh (64%), Balochistant (17%), Punjab (18%), KPK (1%). Right lobe graft without MHV in 90% of recipient (8 patients with MHV) , Average cold ischemia time was 20-25min, while warm ischemia time 35-45min, Mean Duration of transplant surgery 10hrs (8-22hrs), average ICU stay 8 days (4-70 days) with minimum ICU related complications ( 10-15 plural tap, drain placements, 08-10 Psychosis, 3 seizure episode, 4 cardiac events), Overall biliary complications were 15.62%, (leak 8%, Stricture 7%), Survival 8 days to 1160 days, most of our patients are in between 150 to 300 days survival phase and still alive, Estimated 6 months and 1 year survival 85-88 %, overall 16 patients died (most of them in between 1-22 number liver transplant).

CONCLUSION: Overall success, outcome improve as experience grows, public sector LDLT program can achieve results comparable to any other international center and start new era in Living donor liver transplant world which will be beneficial for End stage liver disease.

KEY WORDS: LDLT, ESLD, HBV, HCV, Survival.

Successful journey of 100 living donor liver transplant from stumbling to incline in remote area of Pakistan; beginning of new era.
3 6th Dec 2019.
1830-2000 hrs
Sehrish Sarwar
IMPACT OF SUCCESSFUL HCV TREATMENT ON GLYCAEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AT A TERTIARY CARE CENTRE

Sehrish Sarwar, Junaid Mushtaq, Ibtesaam Amjad, Israr ul Haque, Prof Ghias un Nabi Tayyab

INTRODUCTION: In Pakistan, it is estimated that 17 million people have been suffering from HCV Infection. Growing evidence shows increased prevalence of type 2 diabetes mellitus independent of liver disease stage compared with controls or hepatitis B virus infected patients. Treatment of hepatitis C virus (HCV) with new direct-acting antiviral (DAA) regimens is associated with improved glucose control in patients with type 2 diabetes. Recent studies have suggested that this metabolic amelioration might have a clinical impact on type 2 diabetes mellitus-related complications and liver disease related morbidity and mortality. Our study supports the idea that HCV eradication leads to a reduction in HbA1c in patients with diabetes. It’s an important insight that provides one more reason to continue the eradication of hepatitis C in our population.

OBJECTIVE: To study the impact of glycaemic control after successful treatment with DAA based regimes in Chronic HCV patients with Type 2 Diabetes Mellitus.

MATERIALS AND METHODS: 110 Patients with Chronic HCV, Child-Pugh class A and B, achieving end treatment response after 12 weeks of DAA treatment with Poorly Controlled Type 2 diabetes mellitus with pre-treatment HbA1c equal or more than 7.5 %, already on antidiabetic drugs and compliant to mediations, were enrolled in the study. All patients of Hepatitis C received DAAs in the form of Sofosbuvir 400 mg and Daclatasvir 60. Before starting treatment glycosylated hemoglobin (HbA1c) and Viral load by HCV RNA polymerase chain reaction was also checked. Then these cases were treated with Patients were advised to continue the antidiabetic medications at same dose and timings as advised by the physician Then these cases were followed after three months (12 weeks), where they were assessed again for Viral load by HCV RNA polymerase chain reaction to look for SVR. Patients who achieved End of treatment response after 12 weeks of DAA regimes were also checked for HbA1c level label glycemic control as per operational definition.

RESULTS: In this study, out of 110 patients, 83% of the patients achieved glycaemic control. Age (23-33: 16.5%, 34-44: 40.7%, 44-54: 29.7% p-value=0.728) and gender (Male: 39.6% & Female: 60.4%, p-value=0.142) have no significant association with glycemic control of patients.

CONCLUSION: Our study supports the idea that successful HCV eradication leads to improved glycemic control in patients with Diabetes Mellitus.

KEY WORDS: Glycemic control, DAA, Chronic, HCV, Type 2, Diabetes Mellitus.

Impact of successful HCV treatment on glycaemic control in patients with type 2 diabetes mellitus at a tertiary care centre
4 6th Dec 2019.
1830-2000 hrs
Talal Khurshid
DIAGNOSTIC ACCURACY OF COMPUTED TOMOGRAPHY SCAN, KEEPING ENDOSCOPIC ULTRASONOGRAPHY AS GOLD STANDARD FOR DETECTION OF PANCREATIC CARCINOMA IN PAKISTANI POPULATION

Talal Khurshid, Muhammad Umar, Mashhood Ali
Corresponding author: talalkhurshid@gmail.com Resident GI, PIMS

BACKGROUND: Endoscopic Ultrasonography (EUS) and Computed Tomography (CT) scan are diagnostic techniques that are considerably important in preoperative diagnosis of pancreatic carcinoma (CA). Even though EUS has been confirmed to be more effective in accurate diagnosis but CT scan is still used commonly being easily accessible, cost effective and non invasive in most of developing countries.

AIM: The objective of this study was to determine the diagnostic accuracy of CT scan findings keeping EUS as the Gold Standard procedure.

METHODS & MATERIALS: This cross sectional study was conducted at the Liver centre of Holy Family Hospital, where all 75 suspected cases of pancreatic CA. patients who underwent both; Computed Tomography and EUS, each diagnostic procedure performed by same team of radiologists and gastroenterologists respectively, in the year 2014 were included. The diagnosis of each individual patient for carcinoma of pancreas, confirmed through EUS was taken as gold standard. Sensitivity, Specificity, Positive and Negative predictive values along with 95% confidence intervals (CI) were calculated. Diagnostic accuracy of CT scan compared to EUS was also thereby calculated.

RESULTS: Sensitivity and Specificity of CT scan was found to be as 97.14% (CI=85.08%-99.93%) and 95% (CI=83.08%-99.39%). The positive predictive value was calculated as 94.44% (CI=81.74%-99.32%) while negative predictive value was97.44% (CI=86.52%-99.94%). Diagnostic accuracy was 96%.

CONCLUSION: The diagnostic capability of CT Scan in diagnosis of pancreatic CA is almost nearly effective to EUS

KEY WORDS: Endoscopic Ultasonography, Computed Tomography, diagnosis. Pancreatic cancer, Sensitivity, Specificity, predictive values of test.

Diagnostic accuracy of computed tomography scan, keeping endoscopic ultrasonography as gold standard for detection of pancreatic carcinoma in Pakistani population
5 6th Dec 2019.
1830-2000 hrs
Nazish Butt
Efficacy of Pegylated Interferon-Alpha-2a in Hepatitis D Infected Patients. Experience from the Tertiary Care Hospital in Karachi.

Nazish Butt, Amanullah Abbasi, Riaz Hussain, Lajpat, Sabir, Hanisha Khemani, Ali Khan.
Jinnah Postgraduate Medical Centre, Karachi.

BACKGROUND: Hepatitis Delta Virus (HDV) is a unique virus because it needs Hepatitis B Virus (HBV) for its replication hence, survival. Pegylated Interferon-Alpha-2a (PEG-alfa-2a) is the only option available for the treatment of HDV.

AIM: In the present study, we aimed to assess the efficacy of PEG-alfa-2a in patients with HDV infection.

METHOD: We enrolled all 165 patients with chronic HDV at Gastroenterology section of medical unit IV, Jinnah Postgraduate Medical Centre and at Aga Khan University Hospital, Karachi, Pakistan, On presentation, all patients were positive for both Anti-HDV and HBsAg, who were treated for 48 weeks with PEG-alfa-2a. Evaluation of HBV and HDV infection through Polymerase chain reaction (PCR) was done at 6-month, and 12-month intervals. All laboratory values were repeated on regular intervals to assess the efficacy and side effects of therapy.

RESULTS: From total 165 patients, Eighteen patients lost to follow up, 20 patients stopped treatment due to side effects of Interferon and 20 patients were excluded from the study due to liver cirrhosis, rest of 107 patients, 76 (71%) were male while 31 (29%) were female with a mean age of 27.84±10.52 years. Baseline investigations showed: Hemoglobin 13.12 ± 2.04 gm/dL; platelets 200.73 ± 91.31 x 109/L; Alanine aminotransferase, 67.41 ± 116.15 U/L; Aspartate aminotransferase, 44.18 ± 50.77 U/L; Alkaline phosphatase, 218.20 ± 125.76 U/L; total bilirubin, 0.82 ± 0.92 g/dL; and direct bilirubin, 0.31 ± 0.22 g/dL. On PCR, HDV DNA was confirmed in every collected sample, with a mean value of 10786066.28±31826055.19, while HBV DNA was detected in 44 (41%) patients. Duration of treatment was 12 months, 25 (23%) patients achieved the 48-weeks End Treatment Response (ETR), 27 (25%) patients showed partial response to Peg-INF, while 49 (45%) had treatment failure (Null response or Non-responders). Six (6%) patients had undetectable levels of the viral DNA load at 6-month interval.

CONCLUSION: Interferon therapy in patients with CHD shows a sub-optimal outcome. Only 23% achieved ETR. Patients with treatment failure or null response should urgently be given an effective alternative option.

Figure: Efficacy of Pegylated Interferon-Alpha-2a in Hepatitis D Infected Patients. Experience from the Tertiary Care Hospital in Karachi.

Efficacy of Pegylated interferon-alpha-2a in hepatitis d infected patients. experience from the tertiary care hospital in Karachi.
6 6th Dec 2019.
1830-2000 hrs
Hasmik Ghazinyan
IMPACT OF ACUTE INSULTS ON THE OUTCOMES OF 76 PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE

Hasmik Ghazinyan1, Mher Davidyants1, Lusine Navoyan², Ruzanna Safaryan²
1Department of Hepatology, Nork Clinical Infection Hospital
²Yerevan State Medical University

BACKGROUND: Acute-on-chronic liver failure (ACLF) is clinical syndrome manifesting as acute and severe hepatic derangements with high mortality. The outcome of hepatic decompensation would vary depending on the nature of intervention. The reactivation of hepatitis-B-virus (HBV) is recorded as a leading acute insult of ACLF in the Asian region, but the trends showed an increase in the proportion of alcoholic hepatitis over the years.

AIMS: This study focused on the etiological spectrum of acute insults in ACLF patients and outcomes with different acute insults, according to data of our clinic.

METHODS: We studied the etiology and characteristics of 76 patients presenting with criteria for ACLF based on the APASL 2014 consensus recommendations. Among them 27 retrospectively and 49 prospectively were included. Study period was from 2012 to 2018. Mean age was 47±16 years with a predominance of males (n═54 [71%]).

RESULTS: According to our data, the predominant acute insult was active alcohol consumption [29 (38.2%)], followed by hepatitis-B-virus (HBV) [17(22.4%)], drug-induced-liver-injury (DILI) [15(19.7%)], autoimmune-hepatitis (AIH) flare [5 (6.6%)], hepatitis A, E and D viruses [2 (2.6%)], respectively and unknown [4 (5.3%)]. Patients with 1 and ≥ 2 organ failures were 16% and 84% respectively. Baseline mean laboratory values are given: ALT 710.9±1127 (Range 17-6612) U/L, WBC 10.4±5.2 (Range 3.54-20) x 10³ cells/mm³, Platelets 156.2±99.1 /(Range 19-462) x 10³ cells/mm³, Serum sodium 134.7±9.4 (Range 100-146) mmol/l, INR 2.1±0.6 (Range 1-3), Serum albumin 3.2±0.7 (Range 2-5) g/dL, Serum creatinine 2.1±2.4 (Range 1-8) mg/dL, MELD 22.1±5 (Range 16-34). The overall mortality rate was 32.9 % (25 patients). The mortality in the AIH-ACLF group was the highest [3 (60%)], followed by HBV-ACLF [9 (53%)], DILI-ACLF [5 (33%)], alcohol-ACLF [8 (28%)].

CONCLUSIONS: Active alcohol consumption was and remains the most common acute insult. AIH-ACLF and HBV-reactivation characterized by the highest mortality due to 3 organ failures.

Impact of acute insults on the outcomes of 76 patients with acute-on-chronic liver failure
7 6th Dec 2019.
1830-2000 hrs
Junaid Mushtaq
VALIDATION OF NOVEL FIBROSIS INDEX (NFI) FOR ASSESSMENT OF LIVER FIBROSIS: COMPARISON WITH TRANSIENT ELASTOGRAPHY (FIBROSCAN).

Junaid Mushtaq ( Senior Registrar LGH) Azhar Hussain (Student of 3rd Year MBBS of AMC), Usama Ahmad Yousuf (Student of 3rd Year MBBS), , Bilal Nasir, Israr Ul Haque Toor, Ghias Un Nabi Tayyab

AIM: In this study, we collated cheap and readily available non-invasive bio-markers and fibro scan score in predicting fibrosis stages in chronic hepatitis C infection.

METHODS: We studied on 1898 HCV infected patients confirmed by presence of HCV RNA in their serum. We compared the fibroscan score and fibrosis indices; AST to ALT Ratio, AST to Platelet index, Fibrosis Index, Fibrosis-4, Age to Platelet index , Pohl score, Fibrosis Cirrhosis Index . We developed a new fibrosis index, named Novel Fibrosis Index (NFI) calculated by the following formula: NFI=[(Bilirubin × (ALP)^2) / (Platelet Count (Albumin)^2)]-n.

RESULTS: AAR, APRI, FI, FIB-4, API, Pohl score, FCI and NFI were able to predict fibrosis stage with correlation coefficient indices 0.848,0.711, 0.618, 0.741, 0.529, 0.360 , 0.477 and 0.26 respectively. ROC curves showed sensitivity and specificity for predicting F3 by NFI=75.1%& 41.1% and F4 for NFI= 72.1% and 47.1%, AAR=62.8% & 37.6%, APRI=74.6% & 87.6%, Fib-4=53.2% & 72.3%, FI= 78.1% & 92.3%,API=78.1% & 60%, Pohl score= 38.1% & 78.1% and FCI=78.1% & 88.1%.

CONCLUSIONS: Our NFI not only predicted F3 but also, has been found to have more sensitivity and specificity in predicting F4 fibrosis stage than other fibrosis indices.

KEYWORDS: Hepatitis C, Fibrosis Liver

Validation of novel fibrosis index (nfi) for assessment of liver fibrosis: comparison with transient Elastography (Fibroscan).
8 6th Dec 2019.
1830-2000 hrs
Mohsin Ali
ACUTE LIVER FAILURE: OUTCOME AND PROGNOSTIC PREDICTORS

Mohsin Ali, Jalpa Devi, Amerta Bai, Adil Hassan, Saadat Ali, Muhammad Arsalan, Muhammad Bilal, Sidra Dars, Mashoque Ali, Muhammad Sadik.
Asian Institute of Medical Sciences, Hyderabad

INTRODUCTION: Acute liver failure (ALF) is defined as a rapid hepatic dysfunction and encephalopathy in the absence of pre-existing liver disease. It is relatively uncommon worldwide, however, it progresses rapidly with high mortality. Globally, viral hepatitis is responsible for the majority of cases of ALF.

AIM: This study aimed to determine the etiology, outcome and predictive factors for in-hospital mortality in ALF patients.

METHODS: A descriptive study was conducted with ALF patients hospitalized at the Gastro-Hepatology Department of Asian Institute of Medical Sciences, Hyderabad from May 2018 to September 2019. A total of 31 patients having clinical and biochemical markers suggestive of ALF were included in the study and evaluated for etiology, prognostic factors and outcome during the hospital stay. International Normalized Ratio (INR), sepsis (2 SIRS + confirmed or suspected infection), prognostic scores {King College Criteria (KCC) and Model End-Stage Liver Disease (MELD)} and other prognostic factors were compared.

RESULTS: Thirty-one patients with a mean age of 22 years, 21 (67.7%) were males. Most common etiology was indeterminate 21 (67.7%) while 5 (16.15%) had Hepatitis B and 5 (16.15%) had Hepatitis E. The in-hospital mortality was 19 (61.3%), out of which 14 (73.3%) were males and 12 (38.7%) recovered spontaneously. INR > 5.00 ( 1 survivor and 7 non-survivors, Mean= 3.12 and 4.02 in both groups respectively, p=0.02), MELD score >32 (3 survivors and 12 non-survivors, Mean= 29.58 and 33.31 in both groups respectively, p=0.049), KCC 2 or more out of 5 (1 survivor and 7 non-survivors, Mean= 0.83 and 1.31 in both groups respectively, p=0.068), and sepsis (0 survivors and 8 non-survivors, p= 0.008) were independently associated with in-hospital mortality.

CONCLUSION: The in-hospital mortality of ALF was significantly high with raised INR, MELD (>32), KCC (2/5) and sepsis. Hence, they are poor prognostic factors.

KEYWORDS: Acute liver failure, MELD, KCC.

Acute liver failure: outcome and prognostic predictors
9 6th Dec 2019.
1830-2000 hrs
Muhammad Ali Qadeer
CHARACTERISTICS OF HEPATITIS D INFECTION IN YOUNG ADULTS

Muhammad Ali Qadeer, Zaigham Abbas, Muhammad Asim Sharif, Shoukat Ali Samejo.
Department of Gastroenterology and Hepatology, Dr. Ziauddin university hospital. Clifton Karachi

INTRODUCTION: Hepatitis D a serious and aggressive disease accelerating the progression to cirrhosis and is a significant cause of morbidity in many countries. Existing literature on the prevalence and characteristics of HDV infection in the young adult population is limited.

AIM: This study aims to ascertain disease behavior and its effect on young adults.

METHODS: The case records of 82 HDV RNA positive patients of age between 18-25 years were reviewed. Presence of cirrhosis was clinically assessed by the esophageal varices on endoscopy, an episode of decompensation or a biochemical–ultrasonographic diagnosis when at least two of the following features coexisted, Platelet count below 100 000/mL, AST/ALT ratio > 1, international normalized ratio (INR) > 1.5, splenomegaly (spleen size >12 cm). The primary outcome was designated as an episode of hepatic decomposition, hepatocellular carcinoma, need for a liver transplant or liver-related death. The risk of decompensation was categorized with the help of baseline-event-anticipation (BEA) Classification.

RESULTS: The total number of patients was 82, male 72 (87.8%). Median age 22 years (18-25). Cirrhosis at first presentation was there in 29(35.4%). 26 (31.7%) had received Previously PEG-IFN-based therapy. Laboratory investigations median (range) included hemoglobin 13.9g/dl (7.4-16.6), TLC: 6 x109/L (2.4-15.4), Platelets 186 x 109/L (26-443), bilirubin 0.7 mg/dl (0.2-17.2), ALT 66 IU/L (25-723), AST 54 IU/L (22-390), GGT 40 IU/L (10-942), alkaline phosphatase 113 IU/L (51-395), albumin 4.1 g/dL (1.8-4.8), INR: 1.1 (0.8-2.5). HDV RNA level 575000 IU/ml. HBV-DNA was detectable in 51 (62.2%). HBeAg was reactive in 17 (20.7%). Those with APRI score of more than 1, were 22/82 (26.8%). Cirrhosis was identified in 29/82 (35.4%) of individuals. Among cirrhotics, 6/82 (7.3%) were categorized as Child B or Child C. Out of 82 participants, 13(15.9%) had a MELD score of ≥ 15. Based on BEA-classification, 6/82(7.3%) were categorized as BEA class A, 71/82(86.6%) as BEA class B, and 5/82 (6.1%) as BEA class C (Fig:1)

CONCLUSION: Most of the young adults were male. More than half of them had HBV DNA detectable but most of them were HBeAg negative. One-quarter of the patients were treatment-experienced. High values of AST and ALT indicated increased inflammatory activity. Patients were at a moderate to severe risk of clinical disease progression leading to an event (BEA score). A significant number of patients had already developed cirrhosis (35.4%) indicating aggressive nature of disease in young adults.

Characteristics of hepatitis d infection in young adults

Figure 1: BASELINE-EVENT-ANTICIPATION (BEA) CLASSIFICATION

Characteristics of hepatitis d infection in young adults
10 6th Dec 2019.
1830-2000 hrs
Talal Khurshid
RISK OF FAILURE AND COMPLICATIONS OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; COMPARISON OF ELDERLY AND YOUNG PAKISTANI PATIENTS

Talal khurshid*, Mashood Ali*, Muhammad Umar**, Tayyab Saeed Akhtar**, Madeha Irfan**
* Department of Gastroenterology, PIMS Islamabad.
**Department of Medicine, Holy Family Hospital / Rawalpindi Medical College, Rawalpindi.

BACKGROUND: Endoscopic Retrograde Cholangiopancreatography (ERCP) is an effective diagnostic and therapeutic procedure, widely performed in patients, irrespective of age.

AIM: The objective of the study was to compare the risk of failure and procedural complications in young and elderly patients.

METHODS & MATERIALS: This cohort study was conducted at Holy Family Hospital, where all 362 patients who underwent the therapeutic or diagnostic ERCP performed, in the year 2014 were included and categorized as 276 young (aged 20-59 years) and 86 elderly (60 years and above) patients. The procedural and post procedural records of both study groups were followed up prospectively to compare the risk of failure of procedure and the complications during and after procedure. Chi square test was applied at 5% level of significance and Relative risks (RR) along with 95% confidence intervals (CI) were also determined through SPSS.

RESULTS: Successful therapeutic intended procedures were observed in 95.08% of elderly and 97.32% of young patients. (RR of failure 0.64, CI 0.19-2.85, p value 0.47). Similarly successful diagnostic intended procedures were performed in 88% of elderly and 91.1% of young patients. (RR of failure 1.35, CI 0.37-4.84, p value 0.64). At least one or more Procedural and post procedural complications were observed in 9.3% and 8.3% of elderly and young patients respectively (p value 0.77), where risk of complications was also observed to be the same with relative risk of 1.11 (CI 0.51-2.40)

CONCLUSION: The success rates, risk of failure and complications of the procedure in elderly was same as that of young, providing evidence that it is an equally safe procedure for elderly too.

KEY WORDS: Cholangiopancreatography, Endoscopic Retrograde, Age groups, risk, complications

Risk of failure and complications of Endoscopic Retrograde Cholangiopancreatography; comparison of elderly and young Pakistani patients
11 8th Dec 2019.
8000-0915 hrs
Azhar Hussain
PATIENTS PREFERENCES FOR GENDER OF ENDOSCOPIST FOR ENDOSCOPIC PROCEDURES

Azhar Hussain, Asim Ali, Dr. Muhammad Asif Gul

INTRODUCTION: Endoscopy is one of the fields that have completely changed our vision of looking into the GI diseases and their treatment. To choose doctor on gender basis is evident in many specialties like gastroenterology where patient preferences regarding the gender of their physicians are a highly sensitive issue and this study highlights this issue in particular.

AIM: to determine the patients preferences for gender of endoscopist for endoscopic procedures.

MATERIAL AND METHODS: This cross sectional study was conducted in Department of Gastroenterology, Lahore General Hospital, Lahore from March 2018 to January 2019. Data was collected with non-probability consecutive sampling. Consecutive patient schedule for elective outpatient upper or lower endoscopy were potentially asked to complete questionnaire on demographic factors including age, marital status, employment status, education, height, and weight, sex preferences for the endoscopist who perform the EGD and colonoscopy etc.

RESULTS: Of 2148 patients, 1161 (54.1%) were males and 987 (45.9%) were females. During research, 1686 (78.6%) patients underwent upper GI endoscopy, 350 (16.3%) patients underwent lower GI endoscopy, 82 (3.8%) patients upper and lower GI endoscopy, 14 (0.7%) patients underwent ERCP and 16 (0.7%) patients underwent peg tube insertion. 682 (31.8%) preferred male endoscopist, 689 (32.1%) preferred female endoscopist while 777 (36.2%) showed no preference at all. The relationship of gender preference and religion, education, endoscopic procedure, family pressure, competency of doctor, personal comfort level, previous experience with the same doctor and satisfaction of the patients was statistically significant with p>0.05.

CONCLUSION: One third of patients showed their preference for particular gender of doctor. Mostly patients preferred their endoscopist to be of similar sex. By heeding the patients’ preferences for particular procedure will enhance and facilitate the trustful atmosphere in the clinical setting, lessen the level of uncertainty and stress of both doctor and patient, and thus, enchanting better and favorable treatment and increasing compliance and adherence to endoscopic surveillance programs.

KEYWORDS: Gender preferences, Endoscopy, compliance and adherence

Patients preferences for gender of endoscopist for endoscopic procedures
12 8th Dec 2019.
8000-0915 hrs
Saleha Bibi
RELATIONSHIP BETWEEN PSYCHOLOGICAL WELLBEING AND LIVER DISEASES

Saleha Bibi, Misbah Waqar, Sumaira Bibi
Army Special Education Academy, Fort Road, Rawalpindi

BACKGROUND: Previous research has described how psychological conditions can lead to increased risk of cardiovascular disease which, in turn, may develop into obesity, raised blood pressure and then eventually to liver disease.

OBJECTIVE: The present study was conducted to investigate the level of psychological distress among liver disease patients.

MATERIAL AND METHOD: Study was conducted at the hospitals of Rawalpindi and Isalmabad using purposive sampling technique. Sample of the study consisted of 200 individuals including 100 liver patients having Hepatitis C and 100 normal individuals. Age range of the sample was 25-45 years. Sixty two percent were men and 38% women participated in the study. Psychological wellbeing was measured by using Psychological Wellbeing Scale. Demographic data sheet devised by the authors was used which contained information including patient's name, age, gender and socioeconomic status etc.

RESULTS: Data was analysed through SPSS 21 and appropriate statistical tests correlation, t-test and one way ANOVA were used to draw results. Our study revealed that people having Hepatitis C scored less in psychological wellbeing scale with mean 33.2, SD 10.3 as compared to normal individuals mean 53.3, SD 14.1, p-value 0.002. Furthermore our study revealed that people with chronic liver diseases have low level of psychological wellbeing mean 29.1, SD 8.4, as compared to people with acute liver diseases mean 42.3, SD 11.4, p-value is 0.004. Independent sample t-test revealed that female liver patients have poor psychological wellbeing mean 12.3, SD 7.1, as compared to male liver patients mean 18.3,SD 9.4.

CONCLUSION: Our study concluded that liver disease is predicts psychological wellbeing. We already know that psychological wellbeing predicts physical health. But our also justified that physical health also predicts psychological wellbeing.

KEYWORDS: psychological wellbeing; Liver Diseases; Chronic

Relationship between psychological wellbeing and liver diseases
13 8th Dec 2019.
8000-0915 hrs
Mohammad Salih
THE SAFETY AND EFFICACY OF ERCP IN THE PEDIATRIC POPULATION WITH STANDARD DUODENOSCOPE BY ADULT GASTROENTEROLOGISTS

Salih M, Malik HZ, Abbas Y, Salamat A, Shah NJ

INTRODUCTION: Although endoscopic retrograde cholangiopancreatography (ERCP) has well established efficacy in adult population, there is limited data available regarding its outcomes and complications in children, especially from countries where pediatric gastroenterology is not well established.

OBJECTIVE: To determine the safety and efficacy of ERCP in the pediatric population by adult gastroenterologists with standard duodenoscope at a tertiary care referral center in Pakistan.

METHODS: A retrospective chart review was conducted for all patients up to twelve years of age who had undergone ERCP In last two years. Demographic data along with indications, intra-procedural details, and completion of procedure, diagnoses, interventions and complications were recorded.

RESULTS: A total of 52 procedures were performed in 35 patients (mean age 8.3 ± 2.6 years, range 3 -12 years). Mean weight of the patients was 24.5 ± 9.0 kg. Indications included recurrent pancreatitis or chronic pancreatitis (26, 74.2%), acute pancreatitis (2, 5.7%), abdominal pain (2, 5.7%) choledochal cyst (1, 2.9%), choledocholithiasis (4, 11.4%), biliary stricture (2, 5.7%), Cholestatic LFT patterns (2, 5.7%) and cholangitis (1, 2.9%). Endoscopic cannulation of any duct was achieved in all patients while desired duct cannulation and completion of procedure were achieved in 33 patients (94.3%). Over all complications were observed in 4 (11.4 %) patients, with minor intra-procedural bleeding and mild post-procedural pain being the most common (2, 5.7%). One patient with pain developed post-procedural mild pancreatitis (1, 2.9%).

CONCLUSION: ERCP can be safely performed in pediatric population using adult duodenoscope with good outcomes and acceptable complication rates.

The safety and efficacy of ERCP in the pediatric population with standard duodenoscope by adult gastroenterologists
14 8th Dec 2019.
8000-0915 hrs
Shoukat Ali
PATTERN OF ALCOHOL CONSUMPTION AND ALCOHOL RELATED LIVER DISEASE IN PAKISTANI POPULATION

Shoukat Ali, Zaigham Abbas, Muhammad Asim, Kanwal Tahir
Gastroenterology Department Ziauddin Hospital Clifton Karachi.

INTRODUCTION: Not much data is available about the pattern of alcohol consumption in patients with alcoholic related liver disease (ARLD) in Pakistani population.

AIM: The aim of study was to find the pattern of alcohol consumption in patients with alcoholic related liver disease (ARLD) in Pakistani population.

METHODS: Patient visiting the liver clinic with disturbed LFT’s and history of alcohol intake were included in this study. Patients were labeled as after excluding all other causes of deranged LFT’s. Data about alcohol dependence was recorded on DSM-V. These patient were further evaluated by detailed history, routine investigations, insulin level, abdominal ultrasound and Fibroscan. HOMA-IR was calculated for insulin resistance.

RESULTS: Total number of patients visited liver clinic with ARLD were 121, male 98% median age 45.5 (26 to 78 years), mostly muslims 78.5%. Median duration of alcohol intake was 5-7 years , all the patient was taking 40-44% alcohol. Patients took alcohol empty stomach before dinner. Most common associated addiction was smoking followed by hashish. Extramarital affair was admitted by 16.5%. Binge drinking was admitted by 42.9%. DSM criteria showed dependency of alcohol in 72%. Associated co-morbids were diabetes 12.3% (15/121); hypertension 11.5%(14/121); and ischemic heart disease 3.3%(4/121). Among 115 patients with fatty liver, 108 patients had steatohepatitis evidence as raised alanine transaminase. Significant fibrosis (F3-F4) was present in 72% of patients. The number of patient with cirrhosis 17.3% (21/121), 17/21 had compensated cirrhosis, 3/21 had decompensated cirrhosis, three of them developed HCC. One had Acute on chronic liver failure. Pancreatitis developed in 4.1% (5/121) patients. Laboratory investigations revealed a mean hemoglobin of 12.3±1.82, 11.5 % (14/121) had hemoglobin less than 10 g/dL; mean bilirubin 2.05±3.3 mg/dl. We could not find any correlation of alcohol intake with severity of elasticity and controlled attenuation parameter.

CONCLUSION: ARLD is not uncommon in our population. It is mainly male dominantly disease, with large number of muslim patients. All of these patients were consuming large amount of highly concentrated alcohol, most of them were dependent of alcohol intake.

Pattern of alcohol consumption and alcohol related liver disease in Pakistani population
15 8th Dec 2019.
8000-0915 hrs
Azhar Hussain
STRATIFICATION OF VARIATION OF PROTHROMBIN TIME (PT) AND ACTIVATED PARTIAL PROTHROMBIN TIME (APTT) WITH FIBROSCAN MEASURED LIVER STIFFNESS INDEX (LSI) IN DIFFERENT STAGES OF FIBROSIS.

Azhar Hussain (3rd Year MBBS), Usama Ahmad Yousuf (3rd Year MBBS), Junaid Mushtaq, Ghias ul Hassan, Israr Ul Haque Toor, Ghias Un Nabi Tayyab

BACKGROUND: In most cases, hepatitis C progresses gradually to chronic disease, frequently patient being unaware until progression to advanced fibrosis and cirrhotic stages. Clotting profile (PT & APTT) has been integral part of comprehensive assessment of patients presenting with liver impairment and they are among readily available liver function tests. We studied variation of PT, APTT with Fibroscan score in determining stages of fibrosis.

AIMS: To study variation of PT, APTT with Fibroscan score in various stages of fibrosis.

METHODS: The retro-prospective cross sectional study was carried out at LGH, Lahore from February 14, 2018 to January 14, 2019. We studied on 260 HCV infected patients. Patients having coagulation pathologies other than liver impairment were excluded. Patients were assessed for PT, APTT and fibrosis stage was determined by Fibroscan score. To determine the significant association between continuous variables and liver fibrosis stages, Spearman’s rank correlation was used.

RESULTS: For stage F0-F1 and F2, PT and APTT variables showed non- significant relationship (p >0.05) while for stage F3 and F4, significant relationship with found with p=0.022 and p=0.01 respectively. Patients with F4 (cirrhotic) stage had second highest distribution

CONCLUSION: PT, APTT can be used as prognostic markers efficiently at stages of advanced fibrosis and cirrhosis while initial stages of fibrosis don’t affect PT, APTT significantly. Implication of study can be limited by pathological factors other than liver disease existing in individual cases.

KEYWORDS: Prothrombin Time (PT), Activated Partial Prothrombin Time (APTT), Liver Stiffness Index (LSI)

Stratification of variation of prothrombin time (PT) and activated partial prothrombin time (APTT) with fibroscan measured liver stiffness index (lsi) in different stages of fibrosis.
16 8th Dec 2019.
8000-0915 hrs
Nazish Butt
LIVER DISEASES IN PREGNANCY: TRENDS AND THEIR CONSEQUENCES IN MOTHER AND CHILD

Authors: Butt N1, Soomro SA1, Rasheed M1, Yasmin H2, Seetlani N2, Channa RH1, Rai L1 , Khemani H 1, Abbasi A3,

1. Gastroenterology Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
2. Gynecology and Obstetrics department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
3. Medical Unit II, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan.

INTRODUCTION: Liver diseases in pregnancy is associated with complications and sometimes worse outcome for both mother and baby. It occurs in approximately 3% of all pregnancies, and may lead to various maternal and perinatal morbidities, some of them with fatal consequences for both mother and child.

OBJECTIVE: To determine the trends and consequences of liver diseases in pregnancy

METHODS: This prospective study was conducted at Gastroenterology department, ward 23 and Gynecology & Obstetrics department, JPMC, Karachi, Pakistan. All the pregnant women having concomitant liver disease were included in this study. Baseline characteristics and clinical data entered and analyzed by using SPSS version 21.

RESULTS: Total 105 patients were evaluated in the study. Seven patients were lost to follow up and excluded from the study. Mean age was 27.49 ± 6.02 years. Among 98 patients the most common cause was acute hepatitis E virus (HEV) 32 (32.7%) followed by acute hepatitis C virus 24 (24.5%), pre-eclampsia & eclampsia 8 (8.2%), and HELLP syndrome 7 (7.1%). Fortunately, most of the women survived and discharged without any complication 60 (61.2%) while 15 (15.3%) died. Fetal mortality occurred in 40 (40.8%). Poor socioeconomic status, non-primary education, low BMI, and HELLP syndrome were associated with poor maternal outcome. HELLP syndrome, low BMI, low systolic blood pressure of mother, and presence of altered level of consciousness were associated with poor fetal outcome.

CONCLUSION: Liver diseases in pregnancy increases maternal and fetal morbidity and mortality.

KEY WORDS: Liver disease, Pregnancy, HEV, Pakistan.

Liver diseases in pregnancy: trends and their consequences in mother and child
17 8th Dec 2019.
8000-0915 hrs
Talal khurshid
SEROCONVERSION OF HEPATITIS C DURING DIALYSIS IN MAJOR CITIES OF PAKISTAN

Talal khurshid*, Mashood Ali,*Muhammad Umar**, Tayyab Saeed Akhtar,**,Madeha Irfan**
* Department of Gastroenterology, PIMS Islamabad.
**Department of Medicine, Holy Family Hospital / Rawalpindi Medical College, Rawalpindi

BACKGROUND: Hepatitis C is highly prevalent in Pakistan. Several studies worldwide have shown that patients undergoing hemodialysis are at a risk for developing Hepatitis C.

AIM: this study was carried out to determine the proportion of patients undergoing hemodialysis who seroconverted from HCV negative to HCV positive status in our hospitals.

METHODS: This descriptive cross-sectional study was conducted at four tertiary care hospitals of Punjab from January 2016 to March 2016 on patients undergoing hemodialysis currently. With the help of WHO Sample Size Calculator, at confidence level 95%, absolute precision 5% and anticipated population proportion 14%, the minimally required sample size was calculated to be 186 patients but we included 190 patients in our study. Sampling technique was stratified random sampling based on hospital and gender. Our inclusion criterion was all those patients who were Hepatitis C negative (determined by HCV serology, based on the principle of immunochromatography) at the initiation of dialysis and remained negative for the subsequent six months after the initiation of hemodialysis. Our exclusion criteria was all those patients who seroconverted to HCV positive with six months of initiation of hemodialysis (the period corresponding to the incubation period of hepatitis C virus.) and those who were dialyzed on emergency basis. The patients’ records were thoroughly checked and information regarding their HCV status at initiation of dialysis and HCV status in later serology tests was recorded. Patients who were HCV negative at baseline but later confirmed to be HCV positive, based on HCV serology were considered seroconverted. All the data was entered and analyzed in Statistical Package of Social Sciences, SPSS (version 22). For All the categorical variables like gender of patient, renal diagnosis, HCV status positive or negative, etc. frequencies along with percentages were calculated. For continuous variables like age of patient, duration since initiation of dialysis (in months) and duration since seroconverted (in months), mode, mean along with standard deviation were calculated.

RESULTS: Out of 190 patients who were HCV negative at the initiation of dialysis, 93 (i.e. 48.9%) patients converted to HCV positive status whereas 97 (i.e. 51.05%) patients remained HCV negative throughout the study. The mean time taken for seroconversion was 18.04 months (SD ± 15.43) months). The median was 12 months, with an inter quartile range of 14 months.

CONCLUSION: The proportion of HCV seroconversion in our hemodialysis units is very high.

KEY WORDS: HCV, seroconversion, hemodialysis, ESRD, chronic kidney failure, immunochromatography, serology.

Seroconversion of hepatitis c during dialysis in major cities of Pakistan
18 8th Dec 2019.
8000-0915 hrs
Umair Shafqat Radiological spectrum of of HCC in Pakistan Are we diagnosing too late?

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Time Activity
0900-0930 Registration
DAY 1: Thursday, 05 Dec 2019
Venue: Marriot Islamabad
Session-I: Post Graduates Day: Research Workshop
Time: 0930-1110 hrs.
Director: Yasir Waheed
Time Topic Speaker
0930-0940 Welcome Message Masood Siddiq
0940-1000 Study Designs in Medical Research Dilshad Ahmed Khan
1000-1020 Ethics & Integrity in Research Saeed Sadiq Hamid
1020-1040 Data Management & Analysis Aamir Ijaz
1040-1100 How to do a good Meta-Analysis Fasiha Kanwal
1100-1110 Q & A and Discussion
1110-1140 Tea Break
DAY 1: Thursday, 05 Dec 2019
Session-II: Post Graduates Day: Research Workshop
Time: 1140-1310 hrs.
Time Topic Speaker
1140-1200 How to Write a Good Research Paper Amna Subhan Butt
1200-1220 Translational Research “Its Impact on Health Outcomes” Syed Mohammad Wasim Jafri
1220-1240 How to Publish in High Quality Scientific Journals Fasiha Kanwal
1240-1300 How to Improve Research Paper before Submission into Journal and Pre-submission Checklist Yasir Waheed
1300-1310 Q & A and Discussion
1310-1500 Lunch
DAY 1: Thursday, 05 Dec 2019
Venue: Marriot Islamabad
Session-III: Post Graduates Day - Case Based PG workshop
Time: 1500–1830 hrs.
Director: Mohammed Salih
Asst-Director: Dr. Yasir Abbas
Time Cases Speaker Supervisor Moderator Topic Chair persons
1450-1500 Introduction by Workshop Director
1500-1520 Case-1 Hammad Azam Jehanzeb Afridi Masood Siddiq Refractory Ascites Abdul Kadir Dockmeci
Necati Ormeci
Muhammad Iqbal
1520-1540 Case-2 Waqar Ali Shah Adil Naseer Khan Acute on Chronic Recurrent Encephalopathy
1540-1600 Case-3 Kumail Hassan Kazmi Farrukh Saeed Variceal Bleed Management after Endoscopy Failure
1600-1610 Wrap up by chairs
1610-1630 Case-4 Ghulam Fareed Amna Subhan Butt Altaf Alam Sepsis Induced ACLF Seyed Moayed Alavian
Farrukh Saeed
Nadeem Tehami
1630-1650 Case-5 Ajeet Kumar Zahid Azam HBV Induced ALF
1650-1710 Case-6 Hyder Wajid Abbasi Mashhood Ali Khan DILI (Anti TB Drugs induced)
1710-1720 Wrap up by chairs
1720-1740 Case-7 Adnan Shabbir Akif Dilshad Muhammad Salih Pre-Transplant Assessment and Transplant in CLD because of NASH Norah Terrault
Bilal Hameed
Najam Ul Hasssan Shah
1740-1800 Case-8 Ali Qadeer Zaigham Abbas PBC case scenario
1800-1820 Case-9 Umair Shafqat Shahid Rasool Autoimmune Hepatitis Resistant to Steroids
1820-1830 Wrap up by chairs
1900-1930 Dinner
1930 Transfer and Check in Serena Hotel Islamabad

This session will be case based presentations by PG GI trainees; it will be 10 min presentation and 10 min discussion

DAY 2: Friday, 06 Dec 2019
Venue: Serena Islamabad
Session-I: Public Health Seminar
Time: 0900-1040 hrs.
Moderator: Arsalan Shahzad
Chairs: Zhongping Duan, Syed Mohammad Wasim Jafri, Bikha Ram
Time Topic Speakers
0900-0910 Opening and WELCOME Masood Siddiq
0910-0925 Who is Spreading Hepatitis What are we doing about it? Faisal Wasim Ismail
0925-0940 Role of Transfusion Services in Prevention of Hepatitis Nuzhat Salamat
0940-0955 Decentralizing the HCV Health Care Delivery to Primary Care - is it time? Ghias un Nabi Tayyab
0955-1010 Good and Simplified Service Delivery for HCV Care in a Resource Limited Country Imam Waked
1010-1025 Key challenges for HCV Elimination in Public Health Domain Fasiha Kanwal
1025-1040 Media Partnership for HCV and HBV Elimination Wasif Nagi
1040-1100 Tea break
DAY 2: Friday, 06 Dec 2019
Session-II: Public Health Seminar
Time: 1100-1300 hrs.
Chairs: Javaid Aslam Butt, Tassawar Hussain, Om Parkash
Time Topic Speakers
1100-1115 Is Prevention on Back Burner in the Era of DAAs? Hassan Mahmood
1115-1130 Global Progress in Elimination of Hepatitis What do the Numbers Tell us? Saeed Sadiq Hamid
1130-1145 Role of Innovation in Technology and delivery approach for Elimination of Viral Hepatitis Norah Terrault
1145-1200 HCV Elimination, Lessons from Egypt Imam Wakeed
1200-1215 Q&A – Discussion
1215-1230 HCV Elimination in Pakistan Huma Qureshi
1230-1245 Changing the Behavior Public and Personal does it Matter? Mowadat Hussain Rana
1245-1300 Role of Celebrities in Elimination of Viral Hepatitis Shehzad Roy
1300-1400 Lunch & Prayer
DAY 2: Friday, 06 Dec 2019
Session-III: Regional Perspectives
Time: 1400-1450 hrs.
Moderator: Junaid Saleem
Chairs: Kamran Hassan, Javed Afridi, Shakeel Mirza
Time Topic Speakers
1400-1410 Elimination of Viral Hepatitis - Progress in Azerbaijan Gulnara Aghayeva
1410-1420 Elimination of Viral Hepatitis - Progress in Bangladesh Salim Ur Rehman
1420-1430 Elimination of Viral Hepatitis - Progress in Iran Seyed Moayed Alavian
1430-1440 Elimination of Viral Hepatitis - Progress in Turkey Abdul Kadir Dockmeci
1440-1450 Elimination of Viral Hepatitis - Progress in China Zhongping Duan
DAY 2: Friday, 06 Dec 2019
Session-IV: Inaugural Session
Time: 1600-1700 hrs.
1530 Guests to be seated
1600 Arrival of the Chief Guest
1600 National Anthem
1603 Recitation of The Holy Quran
1610-1615 Welcome Address by The President PSSLD & Chair Organizing Committee Masood Siddiq
1615-1620 Address by the Representative of Chinese Delegates Yuemin Nan
1620-1625 Address by the Patron PSSLD Syed Mohammad Wasim Jafri
1625-1627 Presentation of Memento to the Chief Guest by the president PSSLD
1627 Address by the Chief Guest
1650 Close of Ceremony
Tea Break
DAY 2: Friday, 06 Dec 2019
Session-V: Executive Council Meeting
Time: 1730-1830 hrs.
1730-1830 PSSLD Executive Council Meeting Board Room
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DAY 2: Friday, 06 Dec 2019
Session-VI: Free Papers
Time: 1830-2000 hrs.
Chairs: Asim Anwar, Junaid Saleem, Zahid Azam, Nazish Butt
1700-2000 Free papers
2030 Dinner
DAY 3: Saturday, 07 Dec 2019
Venue: Serena Islamabad
Session-I: HBV Symposium I
Time: 0900-0945 hrs.
Moderator: Nadeem Zia
Chairs: Shoaib Shafi, H.M. Ashraf, Shuang Liu
Time Topic Speakers
0900-0915 HBV Viral Quasi-species and its Clinical Significance Li Chen
0915-0930 Effect of Hirudin on Farnessol X Receptor Pathway during Acute Intrahepatic Cholestasis Fan Yang
0930-0945 Nucleoside Analogues Combined with TCM Anti-Fibrosis Ameliorate Prognosis of Chronic Hepatitis B Yuemin Nan
0945-0950 Q&A
DAY 3: Saturday, 07 Dec 2019
Session-II: HDV Symposium
Time: 0950-1130 hrs.
Moderator: Zafar Ali Qureshi
Chairs: Muzaffar Latif Gill, Saeed Sadiq Hamid, Abrar Sheikh
Time Topic Speakers
0950-1010 State of the Art lecture:
HDV Replication and Detection In Hepatocytes
Mario Rizetto
1010-1025 Distribution of HDV Genotypes and its effects on disease course and response to treatment Gulnara Aghayera
1025-1040 The Oncogenic role of HDV infection Zaigham Abbas
1040-1055 Epidemiology of HDV Infection in Middle East Countries and Iranian experience with therapy and control of HDV infection. Seyed Moayed Alavian
1055-1110 HDV Management in 2019 and beyond? Mario Rizetto
1110-1115 Q&A
1115-1130 Tea Break
DAY 3: Saturday, 07 Dec 2019
Session-III: HBV Symposium II
Time: 1130-1255 hrs.
Moderator: Lubna Kamani
Chair: SM Munir, Altaf Baqir Naqvi, Sharbath Khan
1130-1145 Mother to child transmission, HBV Management in Pregnancy Altaf Alam
1145-1200 Management of HBV Cirrhotics with and without Co-infection Sadik Memon
1200-1215 Management of CHB in Patients with kidney disease Arif Mehmood Siddiqui
1215-1220 Q&A
1220-1255 State of the Art lecture:
HBV from Functional to Complete Cure, Do East & West Differ in their Approach?
Norah Terrault
1255-1400 Lunch & Prayer
DAY 3: Saturday, 07 Dec 2019
Session-IV: HCV
Time: 1410-1600 hrs.
Moderator: Faisal Wasim Ismail
Chair: Altaf Alam, Farrukh Saeed, Shumail Zafar
Time Topic Speaker
1400-1415 Point of Care Testing in HCV Saeed Sadiq Hamid
1415-1430 HCV Treatment Naïve in 2019 Ghias un Nabi Tayyab
1430-1445 Treatment Failure in Era of DAAs Zaigham Abbas
1445-1500 Detection of Residual HCV-RNA in Patients who have Achieved SVR is Associated with Persistent Histological Abnormality Yijin Wang
1500-1515 Management of HCV in Decompensated CLD Bilal Hameed
1515-1530 Post Liver Transplant HCV Treatment Norah Terrault
1530-1535 Q&A
1535-1600 State of the Art lecture:
HCV – Could it be Really Eliminated Globally by 2030?
Syed Mohammad Wasim Jafri
1600-1610 Break
DAY 3: Saturday, 07 Dec 2019
Session-V: Care of Cirrhotics Clinical Hepatology
Time: 1610-1710 hrs.
Moderator: Adil Naseer
Chair: Arif Nadeem, Bakht Biland, Noor Muhammad
Time Topic Speaker
1610-1625 Diagnosis of Cirrhosis Staging and Clinical Significance Muzaffar Latif Gill
1625-1640 Management of Ascites in Cirrhotics Amjad Salamat
1640-1655 Role of Albumin in Cirrhotics Beyond Plasma Expansion Nadeem Tehami
1655-1710 Variceal Bleed, New Developments Building on Old Knowledge Necati Ormeci
1710-1730 Tea Break
DAY 3: Saturday, 07 Dec 2019
Session-VI: Cirrhosis - Potpouri
Time: 1730-1900 hrs.
Moderator: Mashood Ali
Chair: Bashir Sheikh, Sadiq Achakzai, Mohammad Inayatullah
Time Topic Speaker
1730-1745 Diagnosis and Management of NAFLD Jiangao Fan
1745-1800 Hepatic Encephalopathy – A Practical Approach Israr Toor
1800-1815 Optimal and Effective use of Medications in Cirrhotics Bilal Hameed
1800-1830 Multi detector CT for Hepatic Fibrosis, parameters and accuracy Aman Nawaz Khan
1830-1845 Pain Management in Cirrhotics Saleem ur Rehman
1845-1900 Algorithms in Care of Cirrhosis vs Traditional Approach or Combination - Pros and Cons Fasiha Kanwal
1900-1910 Q&A
 
2000-2045 Dinner
2100 Cultural Evening
DAY 4: Sunday, 08 Dec 2019
Session-I: Free papers
Time: 0800-0915 hrs.
Chair: Asim Anwar, Junaid Saleem, Zahid Azam, Nazish Butt
0800-0915 Free Paper Session
DAY 4: Sunday, 08 Dec 2019
Session-II: Hepatocellular Carcinoma
Time: 0930-1045 hrs.
Moderator: Asif Farooq
Chair: Shahid Rasool, Ehsan Kiyani, Shahzad Riaz, Saleh Channa
Time Topic Speaker
0930-0945 What should Pakistan do to have an Effective Surveillance for HCC Zahid Azam
0945-1000 HCC treatment BCLS or modified model Najam Ul Hassan Shah
1000-1015 Loco regional Curative and Non-Curative Therapies for HCC Abdul Kadir Dockmec
1015-1030 Out of criterion TACE for HCC Atif Rana
1030-1045 Out of Criterion LDLT for HCC Faisal Saud Dar
1045-1115 Tea break
DAY 4: Sunday, 08 Dec 2019
Session-III: CLD and NASH
Time: 1115-1215 hrs.
Moderator: Arshad Abbasi
Chair: Tanveer Hussain, Ayesha Niazi, Adil Naseer Khan
Time Topic Speaker
1115-1130 Imaging in Chronic Liver Disease Ehsan Kiyani
1130-1145 Noninvasive Serological Markers of Fibrosis in Chronic Hepatitis Habib Jadoon
1145-1200 Pathophysiology of NASH Mohammad Salih
1200-1215 Future Therapies for NASH Bilal Hameed
DAY 4: Sunday, 08 Dec 2019
Session-IV: Case Based Workshops
Time: 1235-1405 hrs.
Time Topic Target Audience Facilitators
1235-1405 Specific Liver Diseases of Pregnancy General Zaigham Abbas, Lubna Kamani, Amna Subhan Butt, Rizwana Chaudhary, Ismat Tanveer
1235-1405 NASH General Saeed Sadiq Hamid, Bilal Hameed, Mohammad Naseer, Om Prakash, Muhammad Hafeez
1235-1405 HCV Diagnosis and Treatment GPs/PGs Syed Mohammad Wasim Jafri, Faisal Wasim Ismail, Naeem Ullah, Saad Ali Khan
1235-1405 MDT for HCC PGs Najam ul Hassan Shah, Norah Terrault, Muhammad Salih
Closing Ceremony 1410-1430 hrs.
Prize & Certificate Distribution
Lunch 1430-1500 hrs.