Hep-net opinion about the management of patients with chronic hepatitis C in Pakistan in the era of available direct acting antivirals

In Pakistan, we have 4.9% prevalence of HCV in general population, with 79% genotype 3. Recently Sofosbuvir has been made available at compassionate price in Pakistan. Management of chronic hepatitis C includes counseling of HCV patients, their proper assessment to select those who need antiviral therapy, initiation of appropriate antiviral agents and duration of therapy, along-with careful monitoring for safety and efficacy. Hepatic status as well as previous history of HCV therapy needs to be taken in the consideration before starting antiviral therapy. Other factors include co-morbid conditions like obesity, DM, NASH, etc. Treatment of special populations like liver transplant patients, patients with HBV co-infection, chronic kidney disease and hemoglobinopathies need special considerations when initiating HCV therapy

Etiology and epidemiology of patients presenting with liver disease during pregnancy

We conducted this study to elaborate the etiology and epidemiology of liver diseases presenting during pregnancy. It was a prospective, observational study. This study was conducted in the Department of Gastroenterology, Fatima Memorial Hospital in collaboration with the Department of Obstetrics and Gynaecology from June 2011 -May 2013. 73 patients were evaluated. Data was evaluated for quantitative and qualitative variables. Outcome of mother, pregnancy and neonates was also recorded were available. During the study period 73 pregnant patients were evaluated for the presence of liver disease giving an incidence of 3.6%. The mean age of the patients was 26.3 +/- 3.8 [median: 26, range: 16 - 45] years. The patients presented at a mean gestational age of 5.8 +/- 2.4 [median: 6, range: 1- 9] months. The mean STB and ALT levelswere 11.5 +/- 8.5 [median: 9.3, range: 1.4 - 48] mg/dL and 943.5 +/- 887.4 [median: 765, range: 13 - 4810] IU/Lrespectively. The mean duration of jaundice and mean hospital stay were 6.82 +/- 5.32 [median: 5, range: 2 - 30] days and 5.6 +/- 2.7 [median: 5, range: 1-18] days. Fulminant hepatic failure was seen in 6.8% of the patients. Acute Hepatitis E was the most frequent diagnosis in our population. Maternal deaths were seen in 8.2%, foetal deaths were seen in 12.3% and neonatal deaths in 6.5%. Liver diseases during pregnancy can have multiple causes and may predict poor outcomes for the patients and neonates

Spinal anaesthesia; comparison between prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia in patients undergoing lower abdominal surgeries

Perioperative shivering is a common problem during spinal anaesthesia. It causes tremendous deleterious effects on metabolism of body. Despite of re-warming and raising the ambient temperature, several drugs are under research to evaluate their preventive role in shivering during anaesthesia like tramadol, butorphanol, midazolam, ketamine and ondansetron. The present study was conducted to evaluate the effect of prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. To compare prophylactic low dose ketamine with ondansetron for prevention of shivering during spinal anaesthesia in patients undergoing lower abdominal surgeries. Randomized controlled trial. Department of Anaesthesia, Nishtar Hospital Multan. November 2012 to May 2013. A total of 256 patients were included in the study divided into two equal groups. In this study basic demographics like age, gender, mean weight and height and type of surgery patients underwent were similar, having no significant difference in both groups, while on comparison in both groups, the frequency of shivering revealed 4.69%[n=6] in K Group and 11.72%[n=15] in O Group while remaining 95.31%[n=122] in K and 88.28%[n=113] in O Group had no findings of the morbidity, p value was calculated as 0.03, which showed significant difference. The result of the study concluded that prophylactic intravenous administration of low dose ketamine [0.25mg/kg] is significantly more effective than ondansteron [4 mg] for prevention of shivering during spinal anesthesia in patients undergoing lower abdominal surgeries

Acute hepatitis E during pregnancy; maternal and foetal outcomes

Liver disorders during pregnancy may have a strong bearing on both mother and the foetus. Acute Hepatitis E is rightly considered to be an emerging infection. Loco-regional studies have shown it to be the most common cause of Acute Hepatitis in pregnant females. We carried out our study to elaborate the demographic profile of pregnant females presenting with Acute Hepatitis E along with the fetomaternal outcomes

Study Design: It was a prospective, observational study

Intervention: None

Settings and Participants: Over a period of two years, 73 pregnant patients were evaluated by our team in the Department of Gastroenterology for suspicion of liver disease

Outcomes and Measurement: Data was evaluated for quantitative and qualitative variables. Outcome of mother, pregnancy and neonates was also recorded where available

Results: During the study period 73 pregnant patients presented with liver disease giving an incidence of 3.6%. Serological evidence of Acute Hepatitis E was found in 50 [68.5%] of the patients. Fulminant hepatic Failure developed in 5 [10%] patients. All five patients with FHF could not survive. There were 4 [8%] intra-uterine deaths, 1 [2%] abortion and 5 [10%] neonatal deaths

Shortcomings: Relatively small sample size

Conclusions: Acute hepatitis E during pregnancy predicts poor outcomes for the mothers, foetus and neonates

Assessment of dengue fever severity through liver function tests

To assess the utility of liver function tests [LFTs] for early recognition and prediction of severity of Dengue fever in hospitalized patients. An analytical study. Services Institute of Medical Science and Fatima Memorial Hospital, Lahore, from September - December 2010. Admitted cases of Dengue fever were divided into 3 groups; mild, moderate and severe increases in aminotransferases. Elevation in LFTs was co-related with good or bad outcome i.e. [survival or complication free stay] or [death or complications]. Results were analyzed in SPSS version 18. Out of the 353 patients with mean age of 37.12 +/- 15.45 years, 245 [69.4%] were males and 108 [30.6%] were females. Seventy five patients [21.2%] had mild elevation of aminotransferases [2 fold increases], 265 patients [75.1%] had moderate increases [3 to 4 fold] and 13 [3.7%] had severe [> 4 fold increase]. ALT was statistically higher in patients with septicemia, hepatic and renal failure [p-value [2] 0.05]. AST was higher in almost all complications. Prolonged hospital stay was associated with raised LFTs and greater complications and mortality. AST was found to be twice as much raised as ALT. AST and ALT were statistically higher in patients with worse outcome thus can lead to early recognition of high risk cases

Post-anaesthetic sore throat in patients with endotracheal tube

It has been noticed in the past that some patients who had undergone surgeries under general anaesthesia regained conscience and complained of sore throat. This study is to determine the ratio of patients under general anaesthesia who will present with post-operative sore throat; and to attempt to reduce that ratio in order to provide a more comfortable recovery to the patients. Sixty four patients eligible to be considered for analysis had follow ups for the next three days and were asked to describe any sore throat feature they might be experiencing after they recovered from anaesthesia. The incidence of sore throat in the patients was 37.5%. An alternative to ETT has to be employed [e.g. LMA]

Stroke; electocardiographic changes

[1] To finding the frequency of various electrocardiographic abnormalities in sufferers of acute stroke [2] Comparing the ischemic and hemorrhagic stroke in this perspective. Observational. Emergency department of Nishtar Hospital, Multan from April 2003 to August 2005. Two hundred patients of acute stroke who presented within 48 hours of the onset of neurological symptoms, were included in the study, irrespective of the comorbid conditions like hypertension, diabetes mellitus, valvular heart disease, coronary artery disease and cardiomyopathy. Majority of the patients had ischemic stroke. ECG changes due to variation in heart rate, rhythm ischemia, QTc prolongation and left ventricular hypertrophy were frequent findings in sufferes of acute stroke. Except atrial fibrillation and left ventricular hypertrophy these changes were more or less similar in two types of stroke. A variety of electrocardiographic abnormalities can be found in sufferers of acute stroke. Except atrial fibrillation and left ventricular hypertrophy, there frequency is more or less similar whatever the type of stroke may be

PONV-A comparative study of meto-clopramide alone and with dexamethasone in strabismus surgery

To determine the efficacy of intravenous metoclopramide alone and in combination with dexamethasone in preventing postoperative nausea and vomiting [PONV] in patients undergoing strabismus surgery. Single blinded, randomized, interventional study. This study was conducted in the department of Anaesthesiology at Nishtar Hospital, Multan from October 2005 to October 2006. After the approval of the hospital's ethical committee, the study was conducted on 60 patients who were randomly divided into two groups, each group containing 30 patients. All of the patients were between 2-14 years of age and were A.S.A-I. Randomization was done by envelope draw method. The patients received either metoclopramide 150 micro g/kg or dexamethasone 150 micro g/kg with metoclopramide 150 micro g/kg combination IV, 30 minutes before the induction of anesthesia. General anesthesia was induced with thiopentone sodium, nalbuphine, succinylcholine and maintained with isoflurane and N[2]O+O[2] in both groups. PONV were evulated postoperatively. Patients in group II who received metoclopramide plus dexamethasone experienced significantly less PONV during the first 24 h after surgery. In this study, a single dose of metoclopramide plus dexamethasone [150 micro g/kg of each drug] produced better antiemetic effects after strabismus surgery than metoclopramide alone