Objective: To assess the quality and patient satisfaction in Endoscopy Unit of Shifa Internationa... more Objective: To assess the quality and patient satisfaction in Endoscopy Unit of Shifa International Hospital. Study Design: Cross-sectional survey. Place and Duration of Study: Division of Gastroenterology, Shifa International Hospital, Islamabad, Pakistan, from July 2011 to January 2012. Methodology: Quality and patient satisfaction after the endoscopic procedure was assessed using a modified GHAA-9 questionnaire. Data was analyzed using SPSS version 16. Results: A total of 1028 patients were included with a mean age of 45 ± 14.21 years. Out of all the procedures, 670 (65.17%) were gastroscopies, 181 (17.60%) were flexible sigmoidoscopies and 177 (17.21%) were colonoscopies. The maximum unsatisfactory responses were on the waiting time before the procedure (13.13 %), followed by unsatisfactory explanation of the procedure and answers to questions (7.58%). Overall, unsatisfied impression was 4.86%. The problem rate was 6.22%. Conclusion: The quality of procedures and level of satisfa...
The aim of the study was comparison of the efficacy of treatment with INF and lamivudine in chron... more The aim of the study was comparison of the efficacy of treatment with INF and lamivudine in chronic hepatitis B. 103 patients with chronic hepatitis B were included in this trial and divided into two groups. Group I consisted of 34 patients treated with INF-alpha (5MU 3x per week during 4-6 months), group II included 69 patients treated with lamivudine (100mg per day during 1-4 years). Virologic, serologic and biochemical factors at ETR were analyzed. Costs of these two therapies were estimated too. In group I HBV DNA clearance was observed in 26/34 cases (76%), seroconversion HBeAg/anti-HBe in 5/34 (15%) and normalization of ALT in 22/30 patients (73%). In group II virological response occurred in 37/69 cases (53%), serological in 16/41 (39%) and biochemical in 34/50 (68%). Patients from group I suffered from adverse events typical for INF therapy. No adverse events were observed in group II. Cost of virological response in group I was 4 500 zl, in group II 8 000 zl, biochemical--I...
JPMA. The Journal of the Pakistan Medical Association, 2004
To asses the presence of steatosis and other histological changes in patients with chronic hepati... more To asses the presence of steatosis and other histological changes in patients with chronic hepatitis C. Liver biopsy samples were reviewed for presence of steatosis, its degree and other histological changes of hepatitis C including necro-inflammatory score, fibrosis grade and these changes were correlated with liver function tests. A total of 109 liver biopsy samples were reviewed. Mean age of the patients was 44.46 +/- 13.93 years and 62 (56.8%) were male. Mean necro-inflammatory score was 2.32 +/- 0.95. Mean fibrosis grade was 1.69 +/- 1.12. No Steatosis was found in 42 (38.5%) samples and mild to severe degree of steatosis was found in 67 (61.5%) samples. In this study, nearly 62% of liver biopsy samples had some degree of steatosis. Whether this steatosis increases occurrence of severe form of fibrosis or is an associated phenomena with chronic inflammation needs to be further clarified.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2003
To review the experience of endoscopic dilation of esophageal strictures at a tertiary care hospi... more To review the experience of endoscopic dilation of esophageal strictures at a tertiary care hospital. Descriptive study. Shifa International Hospital, Islamabad January 1985 to January 2003. Patients presenting with dysphagia who presented at our institution during the past 8 years were reviewed. Their etiology and the number of dilations required for improvement in dysphagia and follow up with any complications were reviewed. All procedures were performed with savary dilators using guide wire without fluoroscopy. A total of 369 patients were seen during this period and 583 procedures were performed. Two hundred thirty-five (63.7%) patients had peptic stricture, 123 (33.3%) had malignant strictures, 08 (2.2%) had non obstructive dysphagia and 6 (1.6%) had corrosive ingestions. The age ranged from 28-68 years. There were 254 (88.5%) males and 115 (31.2%) females. Sixty-seven (11.5%) procedures were performed as inpatient and 516 (88.5%) procedures were done as outpatient. Two to thre...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2004
Cancer antigen 125 (CA-125) is usually used to monitor the course of epithelial ovarian cancer. I... more Cancer antigen 125 (CA-125) is usually used to monitor the course of epithelial ovarian cancer. It has recently been reported that liver cirrhosis is associated with elevated serum CA-125, especially in the presence of ascites. The aim of the study was to evaluate CA-125 as a marker of ascites in patients with liver cirrhosis. Seventy-two (72) patients with liver cirrhosis of different aetiology were studied. Ca-125 levels were measured in stored serum collected from the patients. Ca-125 concentrations were elevated in patients with liver cirrhosis and ascites, irrespective of patients' sex and cirrhosis aetiology. CA-125 concentrations were normal in cases of liver cirrhosis without ascites. Elevated cancer antigen 125 is a sensitive marker of cirrhotic ascites. An inappropriate use of this test in cases of liver cirrhosis in females may suggest the ovarian cancer incident and lead to unnecessary surgical intervention.
JPMA. The Journal of the Pakistan Medical Association, 2005
To review the experience of percutaneous endoscopic gastrostomy (PEG) tube placement and its mana... more To review the experience of percutaneous endoscopic gastrostomy (PEG) tube placement and its management in the last nine years, at a tertiary care center in Pakistan. All patients who underwent percutaneous endoscopic gastrostomy from January 1995 to January 2004 at Shifa International Hospital, Islamabad, were included in this study. The indications, technique, complications and follow up were reviewed. A total of 182 persons underwent this procedure. There were 118 (65.0%) males and 64 (35.0%) females. Age ranged from 55-86 years. One hundred seventy five (96.0%) patients had cerebro-vascular accident, five (2.75%) had Parkinson's disease and two (1.25%) malignancy. More than 99% procedures were successful and no procedure related mortality was noted. Mild PEG site infections were encountered in eighteen (9.8%) patients which were manageable with local treatment and oral antibiotics. Four (2.2%) patients had severe tube site infection and needed parenteral antibiotics. Tube di...
Hepatitis C virus (HCV) diagnosis causes significant psychological stress and anxiety. We thought... more Hepatitis C virus (HCV) diagnosis causes significant psychological stress and anxiety. We thought it would be important to illustrate the anxiety caused by HCV diagnosis in patients from the developing world. This study was conducted at the Shifa International Hospital, Islamabad, between February 2004 and April 2004. All patients who were recently diagnosed with HCV (those who tested positive to anti-HCV and HCV polymerase chain reaction) were given a questionnaire that compared stress due to HCV infection with four other variables, including death of a close family member, divorce, loss of source of income and move to another city. We also analyzed the anxiety level among these patients using the Beck Anxiety Inventory (BAI). We studied 98 patients and 100 healthy controls. Thirty-one (31.63%) patients who were diagnosed with HCV presented only with fatigue. Sixty-three (64.28%) patients admitted that diagnosis of HCV interfered with their daily life in some way. Among the newly diagnosed cases, 48 (48.97%) patients had moderate to severe anxiety (BAI Class B and C). Multi-logistic regression analysis showed that anxiety was related to HCV-related stress (P < 0.002) and self-perceived severity of disease (P < 0.001). HCV diagnosis was significantly more stressful than divorce (59.87 vs 70.95; P < 0.013), loss of source of income (50.52 vs 70.80; P < 0.001), and a move to another city (28.32 vs 70.80; P < 0.001). Diagnosis with HCV is reported to be more stressful than divorce, loss of source of income and a move to another city.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
Lymphoepithelioma-like carcinoma of esophagus is a rare tumor with about 20 cases reported worldw... more Lymphoepithelioma-like carcinoma of esophagus is a rare tumor with about 20 cases reported worldwide. It can involve the salivary gland, esophagus, stomach, thymus, thyroid, breast, lung, uterus, cervix, urinary bladder, and the skin. Its association with Epstein Barr virus has been postulated. We report the case of a 45-year female who had been treated for hepatitis C and esophageal tuberculosis and recovered fully from these conditions. She presented with dysphagia of 2-3 month duration. Endoscopic examination revealed narrowing of the esophageal lumen with a fungating mass at the lower end of esophagus with no extension into the stomach. ACTscan confirmed a mass at the lower end of esophagus with multiple enlarged mediastinal lymph nodes. Histological and immunohistochemistry of esophageal biopsy sample showed lymphoepithelioma-like carcinoma. She was managed with chemotherapy comprising of capecitabine, epirubicin and cisplatin followed by esophagectomy and made full recovery.
Liver can get damaged from various injurious factors which, when acting chronically can result in... more Liver can get damaged from various injurious factors which, when acting chronically can result in liver injury and inflammation. This leads to repair, healing, and fibrosis, which ultimately can result into cirrhosis. Cirrhosis has its consequences and can result in hepatic insufficiency and portal hypertension, which in turn lead to porto-systemic encephalopathy, gastrointestinal bleeding, ascites, renal dysfunction, and ultimately can lead to hepatocellular carcinoma and death.1 Various factors like viruses, toxic substances, drugs, auto immune hepatitis, steatosis and alcohol can result in liver injury. In our scenario, hepatitis B and C are the commonest causes of liver fibrosis and cirrhosis. Multiple mechanisms have been described which lead to liver fibrosis. The central factor is activation of hepatic stellate cells, which occurs from multiple reasons, which cause the quiescent cell to become activated. Injury to hepatocytes and cholangiocytes stimulates hepatic stellates ce...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2004
To determine the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection by d... more To determine the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection by detection of anti-HCV and hepatitis B surface antigen (HbsAg) in general population of Pakistan. Observational. Community clinic of Shifa International Hospital, Islamabad, from January 1998 to June 2004. Sera of healthy adult individuals who presented for medical evaluation as a pre-employment criteria in the Gulf region were examined for presence of hepatitis B surface antigen and anti-HCV antibody. Alanine aminotransferase levels were also determined. A total of 47,538 individuals were examined. Out of these, 2528 (5.31%) were positive for anti-HCV and 1221 (2.56%) individuals had positive HBsAg. Hepatitis B surface antigen and anti-HCV both were found in 92 (0.19%) individuals. Mean age of subjects, positive for HCV antibody was 44 years and 40.5 years for HBV. Ninety-four percent individuals were males and 6% were females. Alanine aminotransferase (ALT) was normal in 56 % of subjects...
Objective: To assess the quality and patient satisfaction in Endoscopy Unit of Shifa Internationa... more Objective: To assess the quality and patient satisfaction in Endoscopy Unit of Shifa International Hospital. Study Design: Cross-sectional survey. Place and Duration of Study: Division of Gastroenterology, Shifa International Hospital, Islamabad, Pakistan, from July 2011 to January 2012. Methodology: Quality and patient satisfaction after the endoscopic procedure was assessed using a modified GHAA-9 questionnaire. Data was analyzed using SPSS version 16. Results: A total of 1028 patients were included with a mean age of 45 ± 14.21 years. Out of all the procedures, 670 (65.17%) were gastroscopies, 181 (17.60%) were flexible sigmoidoscopies and 177 (17.21%) were colonoscopies. The maximum unsatisfactory responses were on the waiting time before the procedure (13.13 %), followed by unsatisfactory explanation of the procedure and answers to questions (7.58%). Overall, unsatisfied impression was 4.86%. The problem rate was 6.22%. Conclusion: The quality of procedures and level of satisfa...
The aim of the study was comparison of the efficacy of treatment with INF and lamivudine in chron... more The aim of the study was comparison of the efficacy of treatment with INF and lamivudine in chronic hepatitis B. 103 patients with chronic hepatitis B were included in this trial and divided into two groups. Group I consisted of 34 patients treated with INF-alpha (5MU 3x per week during 4-6 months), group II included 69 patients treated with lamivudine (100mg per day during 1-4 years). Virologic, serologic and biochemical factors at ETR were analyzed. Costs of these two therapies were estimated too. In group I HBV DNA clearance was observed in 26/34 cases (76%), seroconversion HBeAg/anti-HBe in 5/34 (15%) and normalization of ALT in 22/30 patients (73%). In group II virological response occurred in 37/69 cases (53%), serological in 16/41 (39%) and biochemical in 34/50 (68%). Patients from group I suffered from adverse events typical for INF therapy. No adverse events were observed in group II. Cost of virological response in group I was 4 500 zl, in group II 8 000 zl, biochemical--I...
JPMA. The Journal of the Pakistan Medical Association, 2004
To asses the presence of steatosis and other histological changes in patients with chronic hepati... more To asses the presence of steatosis and other histological changes in patients with chronic hepatitis C. Liver biopsy samples were reviewed for presence of steatosis, its degree and other histological changes of hepatitis C including necro-inflammatory score, fibrosis grade and these changes were correlated with liver function tests. A total of 109 liver biopsy samples were reviewed. Mean age of the patients was 44.46 +/- 13.93 years and 62 (56.8%) were male. Mean necro-inflammatory score was 2.32 +/- 0.95. Mean fibrosis grade was 1.69 +/- 1.12. No Steatosis was found in 42 (38.5%) samples and mild to severe degree of steatosis was found in 67 (61.5%) samples. In this study, nearly 62% of liver biopsy samples had some degree of steatosis. Whether this steatosis increases occurrence of severe form of fibrosis or is an associated phenomena with chronic inflammation needs to be further clarified.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2003
To review the experience of endoscopic dilation of esophageal strictures at a tertiary care hospi... more To review the experience of endoscopic dilation of esophageal strictures at a tertiary care hospital. Descriptive study. Shifa International Hospital, Islamabad January 1985 to January 2003. Patients presenting with dysphagia who presented at our institution during the past 8 years were reviewed. Their etiology and the number of dilations required for improvement in dysphagia and follow up with any complications were reviewed. All procedures were performed with savary dilators using guide wire without fluoroscopy. A total of 369 patients were seen during this period and 583 procedures were performed. Two hundred thirty-five (63.7%) patients had peptic stricture, 123 (33.3%) had malignant strictures, 08 (2.2%) had non obstructive dysphagia and 6 (1.6%) had corrosive ingestions. The age ranged from 28-68 years. There were 254 (88.5%) males and 115 (31.2%) females. Sixty-seven (11.5%) procedures were performed as inpatient and 516 (88.5%) procedures were done as outpatient. Two to thre...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2004
Cancer antigen 125 (CA-125) is usually used to monitor the course of epithelial ovarian cancer. I... more Cancer antigen 125 (CA-125) is usually used to monitor the course of epithelial ovarian cancer. It has recently been reported that liver cirrhosis is associated with elevated serum CA-125, especially in the presence of ascites. The aim of the study was to evaluate CA-125 as a marker of ascites in patients with liver cirrhosis. Seventy-two (72) patients with liver cirrhosis of different aetiology were studied. Ca-125 levels were measured in stored serum collected from the patients. Ca-125 concentrations were elevated in patients with liver cirrhosis and ascites, irrespective of patients' sex and cirrhosis aetiology. CA-125 concentrations were normal in cases of liver cirrhosis without ascites. Elevated cancer antigen 125 is a sensitive marker of cirrhotic ascites. An inappropriate use of this test in cases of liver cirrhosis in females may suggest the ovarian cancer incident and lead to unnecessary surgical intervention.
JPMA. The Journal of the Pakistan Medical Association, 2005
To review the experience of percutaneous endoscopic gastrostomy (PEG) tube placement and its mana... more To review the experience of percutaneous endoscopic gastrostomy (PEG) tube placement and its management in the last nine years, at a tertiary care center in Pakistan. All patients who underwent percutaneous endoscopic gastrostomy from January 1995 to January 2004 at Shifa International Hospital, Islamabad, were included in this study. The indications, technique, complications and follow up were reviewed. A total of 182 persons underwent this procedure. There were 118 (65.0%) males and 64 (35.0%) females. Age ranged from 55-86 years. One hundred seventy five (96.0%) patients had cerebro-vascular accident, five (2.75%) had Parkinson's disease and two (1.25%) malignancy. More than 99% procedures were successful and no procedure related mortality was noted. Mild PEG site infections were encountered in eighteen (9.8%) patients which were manageable with local treatment and oral antibiotics. Four (2.2%) patients had severe tube site infection and needed parenteral antibiotics. Tube di...
Hepatitis C virus (HCV) diagnosis causes significant psychological stress and anxiety. We thought... more Hepatitis C virus (HCV) diagnosis causes significant psychological stress and anxiety. We thought it would be important to illustrate the anxiety caused by HCV diagnosis in patients from the developing world. This study was conducted at the Shifa International Hospital, Islamabad, between February 2004 and April 2004. All patients who were recently diagnosed with HCV (those who tested positive to anti-HCV and HCV polymerase chain reaction) were given a questionnaire that compared stress due to HCV infection with four other variables, including death of a close family member, divorce, loss of source of income and move to another city. We also analyzed the anxiety level among these patients using the Beck Anxiety Inventory (BAI). We studied 98 patients and 100 healthy controls. Thirty-one (31.63%) patients who were diagnosed with HCV presented only with fatigue. Sixty-three (64.28%) patients admitted that diagnosis of HCV interfered with their daily life in some way. Among the newly diagnosed cases, 48 (48.97%) patients had moderate to severe anxiety (BAI Class B and C). Multi-logistic regression analysis showed that anxiety was related to HCV-related stress (P < 0.002) and self-perceived severity of disease (P < 0.001). HCV diagnosis was significantly more stressful than divorce (59.87 vs 70.95; P < 0.013), loss of source of income (50.52 vs 70.80; P < 0.001), and a move to another city (28.32 vs 70.80; P < 0.001). Diagnosis with HCV is reported to be more stressful than divorce, loss of source of income and a move to another city.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
Lymphoepithelioma-like carcinoma of esophagus is a rare tumor with about 20 cases reported worldw... more Lymphoepithelioma-like carcinoma of esophagus is a rare tumor with about 20 cases reported worldwide. It can involve the salivary gland, esophagus, stomach, thymus, thyroid, breast, lung, uterus, cervix, urinary bladder, and the skin. Its association with Epstein Barr virus has been postulated. We report the case of a 45-year female who had been treated for hepatitis C and esophageal tuberculosis and recovered fully from these conditions. She presented with dysphagia of 2-3 month duration. Endoscopic examination revealed narrowing of the esophageal lumen with a fungating mass at the lower end of esophagus with no extension into the stomach. ACTscan confirmed a mass at the lower end of esophagus with multiple enlarged mediastinal lymph nodes. Histological and immunohistochemistry of esophageal biopsy sample showed lymphoepithelioma-like carcinoma. She was managed with chemotherapy comprising of capecitabine, epirubicin and cisplatin followed by esophagectomy and made full recovery.
Liver can get damaged from various injurious factors which, when acting chronically can result in... more Liver can get damaged from various injurious factors which, when acting chronically can result in liver injury and inflammation. This leads to repair, healing, and fibrosis, which ultimately can result into cirrhosis. Cirrhosis has its consequences and can result in hepatic insufficiency and portal hypertension, which in turn lead to porto-systemic encephalopathy, gastrointestinal bleeding, ascites, renal dysfunction, and ultimately can lead to hepatocellular carcinoma and death.1 Various factors like viruses, toxic substances, drugs, auto immune hepatitis, steatosis and alcohol can result in liver injury. In our scenario, hepatitis B and C are the commonest causes of liver fibrosis and cirrhosis. Multiple mechanisms have been described which lead to liver fibrosis. The central factor is activation of hepatic stellate cells, which occurs from multiple reasons, which cause the quiescent cell to become activated. Injury to hepatocytes and cholangiocytes stimulates hepatic stellates ce...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2004
To determine the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection by d... more To determine the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection by detection of anti-HCV and hepatitis B surface antigen (HbsAg) in general population of Pakistan. Observational. Community clinic of Shifa International Hospital, Islamabad, from January 1998 to June 2004. Sera of healthy adult individuals who presented for medical evaluation as a pre-employment criteria in the Gulf region were examined for presence of hepatitis B surface antigen and anti-HCV antibody. Alanine aminotransferase levels were also determined. A total of 47,538 individuals were examined. Out of these, 2528 (5.31%) were positive for anti-HCV and 1221 (2.56%) individuals had positive HBsAg. Hepatitis B surface antigen and anti-HCV both were found in 92 (0.19%) individuals. Mean age of subjects, positive for HCV antibody was 44 years and 40.5 years for HBV. Ninety-four percent individuals were males and 6% were females. Alanine aminotransferase (ALT) was normal in 56 % of subjects...
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Papers by Nasir Khokhar