However, it would be more valuable if they could provide us with the threshold level of HBV DNA reduction at 12 weeks to achieve HBV undetectability in their cases. As a result, the authors in this article1 tested an approach which is absolutely not valid and nor practical at present. Currently, we believe that ETV monotherapy is not a good alternative as a rescue therapy

C646 molecular weight for cases with LAM and or LAM/ADV resistance, whereas continued treatment resulted in virus suppression in a higher percentage of patients in the series of Shim and colleagues. ETV is obviously not a drug with a high genetic barrier to resistance in the setting of LAM refractoriness. In such situations, we have to admit the effectiveness of other alternative drugs, including tenofovir. Yucel Ustundag*, Omer Topalak†, * Zonguldak Karaelmas University School of Medicine, Department of Internal Medicine, Gastroenterology Clinics, Zonguldak, Turkey,

† Dokuz Eylül University School of Medicine, Department of Internal Medicine, Gastroenterology Clinics, Izmir, Turkey. PI3K inhibitor “
“A 50 year old male presented with nodular swellings on his lower limbs, buttocks, abdomen, chest and back for 15 days. He denied any history of abdominal pain or steatorrhea. He was a known hypertensive and a diabetic for three years. He had a history of chronic alcohol abuse (30 years). At presentation his vital signs were stable but he appeared pale. Multiple subcutaneous nodules of variable consistency were present in the lower limbs, abdomen and buttocks. The swellings on the buttock, back and upper chest wall were firm and

tender (Figure 1A and B). The findings of fine needle aspiration cytology and biopsy of the cutaneous lesions revealed lobular panniculitis with foci of fat necrosis. In the areas of necrosis ghost adipocytes were also seen (Figure 2A and B). His investigations revealed low haemoglobin (Hb-7.8 gm/dL) with peripheral blood smear showing macrocytes, microcytes and Tideglusib hypersegmented neutrophils suggestive of combined deficiency anemia. His serum amylase was 2115 U/L and his lipase was 1870 U/L. Serum calcium was 7. 9 mg/dL. Serum triglyceride was 132 mg %. Contrast CT abdomen revealed changes of acute on chronic pancreatitis with evidence of a hypodense collection in the region of head, multiple calcifications and dilation of main pancreatic duct (Figure 3A and 3B). The patient was managed with conservatively and improved with resolution of pain and normalisation in levels of amylase. Panniculitis is inflammation in the adipose tissue which can result from numerous causes. Pancreatic panniculitis is a rare cause of panniculitis resulting from enzyme mediated saponification of fat. Some of the lesions may ulcerate and yield an oily secretion. Histopathology is characterised by a predominantly lobular panniculitis with foci of fat necrosis and an imflammatory infiltrate at periphery.