Search

Therapeutic plasma exchange (PLEX) removes toxins and different mediators from plasma in patients with acute-on-chronic liver failure (ACLF).To observe the safety and outcome of PLEX in ACLF patients in Bangladesh.Twenty-eight patients with ACLF attending Bangabandhu Sheikh Mujib Medical University from September 2020 to May 2021 were enrolled in the study. The patients were given different treatment modalities and followed up for 3 months or up to death. The patients were divided into two groups, each containing 14 patients of ACLF. One group of 14 patients received standard medical therapy (SMT) for ACLF and the second group of 14 patients received SMT plus PLEX.At 90 days, a total of 13 patients (46.43%) survived, of them 8 (57.1%) belonged to PLEX group and 5 (35.7%) were from SMT group. Serum bilirubin and ALT declined significantly after 7 and 30 days but not after 90 days in PLEX group in comparison to SMT group (The study presented here has shown that PLEX is safe in Bangladeshi in ACLF patients, but its efficacy remains to be checked in large-scale randomized trial or in combination therapy with other procedures in ACLF patients.Al Mukit A, Al Mahtab M, Rahim MA

Introduction Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV. Materials and methods In this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated. Results Upper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evaluation of CLD was: Sensitivity 92.3%, specificity 66.7%, accuracy 90.0%, positive predictive value (PPV) and negative predictive value (NPV) were 96.6 and 46.2% respectively. True positive was 84 cases, false positive 3 cases, false negative 7 cases, and true negative 6 cases. If we consider cut-off value as 909 in the evaluation of EV in CLD, then true positive was 85 cases, false positive 3 cases, false negative 6 cases, and true negative 6 cases. From this, by calculation, sensitivity was 93.4%, specificity 66.7%, accuracy 91%, PPV 96.6%, and NPV 50%. Conclusion The platelet count/spleen index may be proposed to be a safe and reliable mean of screening of EV in CLD patients; however, case-control study would be required to validate this. How to cite this article: Hossain E, Ahammed F, Saha SK, Foez SA, Rahim MA, Noor-e-Alam SM, Abdullah AS. Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease. Euroasian J Hepato-Gastroenterol 2018;8(1):18-22.

BackgroundHepatic venous pressure gradient (HVPG) reflects the portal pressure in patients with cirrhotic portal hypertension. The aim of the study was to assess the relation of HVPG to variceal size, Child—Pugh status, and variceal bleeding.Materials and methodsA total of 96 patients with cirrhosis of liver were enrolled prospectively and each patient's HVPG level was measured via the transfemoral route. Clinical and biochemical evaluation and upper gastrointestinal (GI) endoscopy were done in each subject. Severity of cirrhosis was assessed by Child's status.ResultsThe mean HVPG was higher in patients with Child's B and C (14.10 ± 7.56 and 13.64 ± 7.17 mm Hg respectively) compared with those of Child's A (10.15 ± 5.63 mm Hg). The levels of HVPG differed significantly between Child's classes A and B (p = 0.011) and Child's A and C (p = 0.041). The mean HVPG was also higher in bleeders compared with nonbleeders with large varices (17.7 ± 5.5vs14.9 ± 4.7 mmHg respectively; p = 0.006).ConclusionHepatic venous pressure gradient seems to be important to assess the severity of liver cirrhosis.How to cite this articleAl Mahtab M, Noor E Alam SM, Rahim MA, Alam MA, Khondaker FA, Moben AL, Mohsena M, Akbar SMF. Hepatic Venous Pressure Gradient Measurement in Bangladeshi Cirrhotic Patients: A Correlation with Child's Status, Variceal Size, and Bleeding. Euroasian J Hepato-Gastroenterol 2017;7(2):142-145.

How to cite this article: Mahtab MAL, Akbar SMF, et al. Alarming Levels of Hepatitis C Virus Prevalence among Rohingya Refugees in Bangladesh: Emergency National and International Actions Warranted. Euroasian J Hepatogastroenterol 2019;9(1):55-56.

Bangladesh is one of the countries facing huge burden of hepatocellular carcinoma (HCC). Hepatocellular carcinoma is the third commonest cancer in the country and it is just behind to cancer of the lung and cancer of the stomach. Hepatitis B virus (HBV) is responsible for 66% of HCC in Bangladesh. Presumptive prevalence of HBV and hepatitis C virus (HCV) may be as high as 5.4 and 0.84%, respectively, in Bangladesh, and liver diseases occupied 8 to 12% of admission in medicine wards of Public Medical College. In this mini review, I would like to highlight the impact of HBV and HCV in the development of HCC and the management of HCC from a Bangladesh perspective. How to cite this article: Noor-E-Alam SM. Management of Hepatocellular Carcinoma: Bangladesh Perspective. Euroasian J Hepato-Gastroenterol 2018;8(1):52-53.

Hepatitis B virus (HBV) infection is endemic in Bangladesh. Studies have indicated that HBV is the major cause of chronic hepatitis B (CHB), liver cirrhosis (LC), and hepatocellular carcinoma (HCC) in this country. Recently, HBV-related acute on chronic liver failure (HBV-ACLF) has emerged as a serious and emergent medical problem in Bangladesh. To develop a strategy to address HBV-related problems and their influence on health care delivery system, proper understandings about extent of problems and nature of economic burden should be explored. Conservative estimates indicate that about 50 million or more of Bangladeshi have been infected by HBV at some point of their life. Out of the total Bangladeshi population, about 2 to 5% is chronically infected with HBV (about 3–8 million) (1–6%) and considerable number of these patients will eventually develop LC, HCC, or ACLF (about 1 million). Although proper statistics is lacking, it is estimated that HBV-related liver diseases account for a majority of hospital admissions and around 20,000 deaths every year in Bangladesh. In addition, complex clinical features of HBV-related liver diseases have been documented in Bangladesh that show similarity and differences from HBV infection in other Asian countries. Although vaccination against HBV and containment of horizontal transmission are in progress in Bangladesh for reduction of new HBV infection, there is a lack of national strategy for treatment of millions of chronic HBV-infected subjects. This paper will provide an insight regarding the economic impact of HBV in Bangladesh that may act as a primary impetus for developing national HBV eradication program, a goal set by World Health Organization (WHO). How to cite this article Al Mahtab M, Chaudhury M, Uddin MH, Noor-E-Alam SM, Rahim MA, Alam MA, Moben AL, Khondaker FA, Choudhury MFI, Sarkar MJA, Poddar PK, Foez SA, Akbar SMF. Cost Assessment of Hepatitis B Virus-related Hepatitis in Bangladesh. Euroasian J Hepato-Gastroenterol 2016;6(2):163-166.

A 35-year-old man was admitted to hospital with severe anemia. Two years back, he had presented with bleeding esophageal varices and subsequently diagnosed as a case of chronic liver disease with portal hypertension. He was then treated with esophageal band ligation. He tested positive for hepatitis B surface antigen with HBV DNA levels of 4 × 106 copies/ml by PCR. His repeat endoscopy showed grade 1 esophageal varices with no evidence of recent or active bleeding. On further investigation, his bone marrow showed dimorphic erythroid hyperplasia with ring sideroblasts and diagnosis of sideroblastic anemia was made. Although rarely, it was suggested that as cirrhosis is a chronic process, it may cause nutritional deficiency, which in turn may lead to the development of anemia. How to cite this article Al-Mahtab M, Rahim A, Noor-e-Alam SM, Khandokar FA, LutfulMubin A, Rahman S. A Case Report of Decompensated Cirrhosis of Liver with Sideroblastic Anemia. Euroasian J Hepato-Gastroenterol 2015;5(1):55-56.