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Background: Hepatitis is an escalating problem in Pakistan due to lack of awareness about its risk factors. Objectives: To create awareness about risk factors for hepatitis in patients coming for its treatment at a tertiary care hospital using a counseling intervention. Patients and Methods: The study was conducted at civil hospital, Karachi. Patients having hepatitis B or C were enrolled. Each patient filled a pre and post counseling questionnaire (after 6 months). Results A total of 153 hepatitis positive patients were counseled. There were 108 females and 45 males. Majority (83) had hepatitis C virus, 56 had hepatitis B virus, 08 had co-infection of hepatitis B virus and hepatitis D virus and 06 had hepatitis B virus with hepatitis C virus. Counseling was done on multiple parameters. Pre counseling figures for using brand new syringes were 32% which improved to 81% after counseling, for using screened blood these changed from 22% to 81%, for sterilized dental instruments they improved from 21% to 65% and for avoiding road side barbers they improved from 58% to 78%. The figures for hepatitis B virus vaccination in hepatitis C virus patients rose from 3% to 36.6% and for families rose from 2.6% to 43.1%. Conclusions: Great improvements were seen in the awareness and health seeking behavior of hepatitis cases following behavior change communication. Policy message: More stress should be given on preventive strategies through mass awareness and counseling programs to control disease spread. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is associated with poor outcomes after orthotopic liver transplantation (OLT). We report on six high-risk end-stage liver disease (ESLD) patients who underwent percutaneous coronary intervention (PCI) with bare metal stents during the preoperative evaluation process. There was no mortality or major adverse cardiac event (MACE) within 90 days of OLT. These patients had advanced models for end-stage liver disease sodium (MELD-Na) scores (mean 24.5), thrombocytopenia (mean 70,500 µL⁻¹), and elevated international normalized ratio (INR; mean 2.0), who tolerated stent implantation followed by modified antiplatelet regimens. Percutaneous coronary intervention may facilitate listing with good OLT outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Institutional Review Board of Rutgers University New Jersey Medical School issued approval (Pro2019000277). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Raza et al.)

Although the On-X aortic valve (AO) is considered less thrombogenic compared to its counterparts, we present a case where recurrent thromboembolic ischemic stroke occurred, first with a slightly sub-therapeutic, then even with an elevated International Normalized Ratio (INR).  A 36-year-old male, the background of On-X AO replacement but no other risk factors, developed thromboembolic stroke twice while on Warfarin, first with INR 1.4, second with INR 2.4. Despite extensive investigation, other than elevated levels of low-density lipoproteins, no other treatable cause was found with the latter episode. The INR range was increased to 2.5-3.5, and aspirin and statin were added. The occurrence of thromboembolic stroke with an On-X AO despite maintaining an INR of 2.4, presents a dilemma for future prevention. The American Heart Association (AHA) and the American College of Cardiology (ACC) guidelines for thromboembolism prevention in case of an On-X AO recommend an INR range of 1.5-2 as being effective when warfarin is used along with aspirin. The take-home message is that the recommendation of an INR range of 1.5-2 with an On-X AO should be approached with caution; aspirin should be strongly considered regardless of the presence of thromboembolic risk factors. Patients developing thromboembolism have a high risk of recurrence. Therefore, a higher INR, along with the addition of aspirin and statin should be considered. Studies are needed to establish guidelines for a reliable INR range in these scenarios., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hashmi et al.)