Lubna Kamani

Background and objective: Hepatitis E virus is a major cause of acute viral hepatitis and is endemic in Pakistan, where it contributes substantially to morbidity and mortality among women of childbearing age. The Hecolin vaccine is a potentially useful preventive measure, but data on its safety in this population remain limited. This study assessed the safety and tolerability of hepatitis E vaccination in non-pregnant women of childbearing age. Methodology: This prospective, multicenter observational study was conducted at Jinnah Postgraduate Medical Centre and Atiya General Hospital, Karachi, Pakistan, from September 2023 to September 2025. Using non-probability convenience sampling, 375 non-pregnant women aged 16–43 years, stratified into 16–22 and 23–43-year subgroups, received at least one vaccine dose and were followed for 21 days. Data were collected by structured questionnaire and analyzed with descriptive statistics and the Chi-square test, with p ≤ 0.05 considered significant. Results: Among the 375 non-pregnant women (mean age 24.47 ± 5.44 years), 72 (19.2%) were married and 303 (80.8%) unmarried; occupations included students (39.5%), housewives (24.8%), caretakers (14.7%), teachers (6.9%), office workers (5.6%), laborers (5.3%), and doctors (3.2%), and 369 (98.4%) resided in Sindh. Adverse effects were mild, transient, and most frequent after the first dose fever (3.7%), flu-like symptoms (4.8%), headache (1.9%), and cold sores (0.3%) all declining on subsequent follow-ups, with no serious adverse events and similar tolerability across age groups. Conclusion: Hepatitis E vaccination is safe, well-tolerated, and acceptable in non-pregnant women of reproductive age in endemic settings, supporting its inclusion in public health programs to reduce hepatitis E-related morbidity and mortality. Further studies should assess long-term protection and safety in pregnancy.

Objective: To determine the frequency of Hepatitis-E prevalence among blood donors at a tertiary care hospital in Karachi. Methodology: A cross-sectional study was conducted among healthy blood donors at the blood donation facility of Liaquat National Hospital (LNH) by Departments of Gastroenterology, Hepatology and Microbiology from October 2020 to January 2022. The blood samples were screened for Hepatitis E virus (HEV) using anti-HEV antibodies (IgG and IgM). Those who tested positive for anti-HEV IgM were tested for HEV-RNA by real-time reverse transcription polymerase chain (PCR). Results: A total of 515 individuals were screened. The mean age was 30.08±7.56 years, and all were males. The mean ALT values recorded were 42.8447±32. Anti HEV IgG was positive in 366 individuals (71%). Anti HEV IgM was positive in 31 (6%) individuals, but HEV - RNA PCR was negative in all IgM+ individuals. Conclusion: The high seroprevalence of Anti HEV IgM among healthy blood donors emphasizes the need for robust measures of routine screening for HEV of all blood products in endemic countries to prevent transfusion dependent transmission with special consideration when the recipients are either immunocompromised or pregnant.

Background Acute-on-chronic liver failure (ACLF) is a rapidly progressive syndrome marked by high short-term mortality. While diabetes mellitus (DM) is known to worsen liver-related outcomes, its specific impact on alcohol-related ACLF (ALD-ACLF) remains underexplored. This study aimed to assess the prognostic impact of DM on 90-day outcomes in ALD-ACLF using data from the APASL ACLF Research Consortium (AARC) database. Methods This observational study involved data from 5612 ACLF patients with documented 90-day outcomes. We identified 2096 patients with ALD-ACLF precipitated by alcoholic hepatitis. Patients with non-ALD etiologies, mixed etiologies, or non-alcoholic precipitants were excluded. Diabetic and non-diabetic patients were compared using 1:2 propensity score matching based on key baseline covariates. Survival outcomes were assessed using Kaplan–Meier analysis and multivariable Cox regression. Results After matching, 109 diabetic patients were compared with 218 well-matched non-diabetic controls. Diabetic patients had significantly lower overall survival (32 vs. 57%) and transplant-free survival (31 vs. 50%) compared to non-diabetics (log-rank p < 0.001). On multivariable Cox regression, DM was independently associated with increased 90-day mortality (HR 1.739, 95% CI 1.262–2.395, p < 0.001), along with elevated serum lactate (HR 1.187 per mmol/L, p < 0.001) and creatinine (HR 1.267 per mg/dL, p < 0.001). Conclusion Diabetes mellitus is a significant independent predictor of mortality in patients with ALD-ACLF. These findings highlight the need for early identification and integrated management of diabetes in ACLF care pathways to improve clinical outcomes.

Non-alcoholic fatty liver disease (NAFLD) is a global problem strongly interlinked with metabolic syndrome. Insulin resistance (IR) is a key factor both in pathogenesis and in the progression to liver fibrosis. This article highlights the frequency of IR in local population. To determine the frequency and associated factors of insulin resistance among non-diabetic patients with NAFLD using HOMA-IR. A prospective cross-sectional study was conducted at Liaquat National Hospital, Karachi. 362 non-diabetic patients diagnosed with NAFLD were divided into two groups: with IR and without IR. Clinical history, physical examination, laboratory tests (fasting lipid profile, fasting glucose, insulin, liver function tests) and abdominal ultrasound with fibroscan for liver steatosis assessment were performed. Controlled Attenuation Parameter (CAP) score of ≥ 238 dB/m was used to define hepatic steatosis and metabolic syndrome was diagnosed based on specific clinical and laboratory criteria. Data was analyzed using SPSS version 27. Total 362 patients were enrolled and 51.7% were male patients. 311(85.9%) participants had insulin resistance. Insulin resistance had significant difference for HDL, LDL, FPG, Fasting plasma insulin, and GGT. Male patients are less likely than female patients to exhibit insulin resistance. Insulin resistance is more common in patients with metabolic syndrome than in non-metabolic patients. Among non-diabetic patients with NAFLD, insulin resistance was highly prevalent and majority of patients were obese. Both genders were affected with IR.

The Hep-Net position paper comes at a significant time in the history of Metabolically Associated Fatty Liver Disease (MAFLD) due to the rapid rise in this disease entity in the past decade. Metabolically Associated Fatty Liver Disease, by its very name, encompasses several common metabolic disease entities, top among those being diabetes and obesity. For Pakistan, the situation is serious as it is among the top 10 countries globally regarding the prevalence of obesity and number one in terms of diabetes, with over a quarter of adults affected. There remains slight ambiguity as regards the nomenclature of MAFLD, with western societies preferring to remove the word “fatty” and substitute with `’steatotic” i.e. MASLD. Regardless of names/titles the metabolic nature of the disease and its management remains the same and fortunately, that is something where universal consensus is present. Under the umbrella of Hep-Net, eminent hepatologists from all over Pakistan have pooled their efforts to formulate guidelines that are specifically tailored to the Pakistani population, its specific lifestyle and relevant interventions that are needed to treat fatty/steatotic liver disease. By virtue of its multi-systemic consequences, metabolic fatty liver disease represents the most significant and expensive disease entity, globally. Prevention, through public education and timely intervention in diagnosed cases will serve to avert a healthcare storm that will far outweigh viral hepatitis. doi: https://doi.org/10.12669/pjms.41.3.10081 How to cite this: Ali B, Kamani L, Salim A, Alam A, Zuberi BF, Farooqi JI, et al. HEPNET Position Statement-I, Case Definition, Classification, Screening & Diagnosis of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Pakistan: A Resource for Primary and Secondary Care Physicians. Pak J Med Sci. 2025;41(3):929-938. doi: https://doi.org/10.12669/pjms.41.3.10081 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Colorectal cancer (CRC) poses a major health challenge worldwide, specifically in developing countries, where late-stage diagnoses lead to substantial mortality rates. This study aims to evaluate CRC knowledge and screening behaviors in Pakistan while identifying barriers that hinder CRC screening uptake. In this cross-sectional study, a paper questionnaire was distributed to patients and companions in hospitals across all provinces in Pakistan between March 2022 and December 2023. Out of 5,244 participants (68.7% male), only 23.2% claimed knowledge of CRC, while 31.5% had some awareness of it. Merely 20.1% believed CRC to be common in Pakistan. Only 6.6% of those aged 50 and above had undergone CRC screening, with 59.7% reporting no prior screening. Notably, 35.9% expressed interest in colonoscopy at age 45 for CRC screening. Screening intentions were lower in younger, female participants, and residents from Balochistan compared to their counterparts. Widowed/divorced individuals showed higher intentions than married ones. Several barriers, including a lack of screening facilities and fear of results, negatively impacted screening intentions. Colorectal cancer awareness and screening uptake remain critically low in Pakistan, with significant barriers including a lack of knowledge, physician recommendation, and access to screening facilities. Sociodemographic factors such as age, gender, education, and region significantly influenced screening intentions. Targeted awareness efforts and improved healthcare provider engagement are essential to enhance CRC screening rates and reduce the disease burden. Kamani L, Shaikh T, Yousaf MS, et al. Colorectal Cancer Screening Knowledge and Associated Willingness and Barriers to Screening in Nationwide Pakistan Cohort. Euroasian J Hepato-Gastroenterol 2025;15(2):156–163.

Doi: https://doi.org/10.12669/pjms.40.11.9687 How to cite this: Abbasi A, Emmanuel AV, Tayyab GN, Shafique K, Kamani L, Nasir MB, et al. Consensus Guidelines on Constipation in Adults in Pakistan. Pak J Med Sci. 2024;40(11):2763-2768. doi: https://doi.org/10.12669/pjms.40.11.9687 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Note: All authors contributed equally in this publication and names are in alphabetical order.

INTRODUCTION: The prevalence of metabolic dysfunction–associated fatty liver disease (MAFLD) and its complication, MAFLD-related acute-on-chronic liver failure (MAFLD-ACLF), is rising. Yet, factors determining patient outcomes in MAFLD-ACLF remain understudied. METHODS: Patients with MAFLD-ACLF were recruited from the Asian Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC registry). The diagnosis of MAFLD-ACLF was made when the treating unit had identified the etiology of chronic liver disease as MAFLD (or previous nomenclature such as non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, or non-alcoholic steatohepatitis-cirrhosis). Patients with coexisting other etiologies of chronic liver disease (such as alcohol, hepatitis B virus, hepatitis C virus, etc.) were excluded. Data were randomly split into derivation (n = 258) and validation (n = 111) cohorts at a 70:30 ratio. The primary outcome was 90-day mortality. Only the baseline clinical, laboratory features and severity scores were considered. RESULTS: The derivation group had 258 patients; 60% were male, with a mean age of 53. Diabetes was noted in 27% and hypertension in 29%. The dominant precipitants included viral hepatitis (hepatitis A virus and hepatitis E virus, 32%), drug-induced injury (drug-induced liver injury, 29%), and sepsis (23%). Model for End-Stage Liver Disease-Sodium (MELD-Na) and AARC scores on admission averaged 32 ± 6 and 10.4 ± 1.9. At 90 days, 51% survived. Nonviral precipitant, diabetes, bilirubin, international normalized ratio, and encephalopathy were independent factors influencing mortality. Adding diabetes and precipitant to MELD-Na and AARC scores, the novel MAFLD-MELD-Na score (+12 for diabetes, +12 for nonviral precipitant), and MAFLD-AARC score (+5 for each) were formed. These outperformed the standard scores in both cohorts. DISCUSSION: Almost half of patients with MAFLD-ACLF die within 90 days. Diabetes and nonviral precipitants such as drug-induced liver injury and sepsis lead to adverse outcomes. The new MAFLD-MELD-Na and MAFLD-AARC scores provide reliable 90-day mortality predictions for patients with MAFLD-ACLF.

Infection with the hepatitis B virus (HBV) poses a serious threat to global public health. More than 300 million instances of chronic hepatitis are brought on by it, which is the primary cause of liver disease. This study was conducted to determine the risk factors of HBV in children at Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan. This cross-sectional study was conducted at the Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan from January 2019 to April 2022. A total of 134 children aged below 16 years with HBV were recruited in this study. Demographic information was recorded. Screening for HBV was done in all patients. Investigations including liver biochemistry, hepatitis B surface antigen (HBsAg), and HBV DNA polymerase chain reaction (PCR) were conducted in the hospital along with a complete blood count and ultrasound whole abdomen. All information was collected on a predesigned proforma and evaluated using statistical package for the social sciences (SPSS), version 25.0, software. The mean age of patients was 11.02 ± 2.19 years. There were 57.46% males. The frequent risk factor was vertical transmission in 47% of children followed by blood transfusion in 23.9% of children, horizontal transmission in 13.4% of children, and prior history of surgical or dental intervention in 17.2% of children. In this study, vertical transmission was the most common route of transmission of HBV. Additionally, 11% of family members were HBV positive. None had concomitant hepatitis C virus (HCV) and HDV infection. All pregnant females should be screened. Children on chronic blood transfusion therapy should be screened annually. Additionally, birth-dose HBV vaccination should be implemented as a key step in HBV prevention among Pakistani children. Butt N, Kamani L, Khemani H. Hepatitis B Risk Factors are Frequently Present in Children at Jinnah Postgraduate Medical Centre in Karachi. Euroasian J Hepato-Gastroenterol 2024;14(1):16–19.