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

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

Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma

Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Acute subdural haematoma is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcome of patients conservatively managed may help the neurosurgeon in the decision-making process. We prospectively analysed 27 patients with age ranges 15-90 years, in whom a CT scan diagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was not initially performed, to the neurosurgery department of Ayub Teaching Hospital Abbottabad [2008-2011]. Patients with deranged bleeding profile, anticoagulant therapy, chronic liver disease, any other associated intracranial abnormalities, such as cerebral contusions, as shown on CT, were excluded from this study. All patients were followed by serial CT scans, and a neurological assessment was done. There were 18 male and 9 female patients, Cerebral atrophy was present in over half of the sample. In 22 of our patients, the acute subdural haematoma resolved spontaneously, without evidence of damage to the underlying brain, as shown by CT or neurological findings. Four patients subsequently required burr hole drainage for chronic subdural haematoma. In each of these patients, haematoma thickness was greater than 10 mm. The mean delay between injury and operation in this group was 15-21 days. Among these patients 1 patient required craniotomy for haematoma removal due to neurological deterioration. Certain conscious patients with small acute subdural haematomas, without mass effect on CT, may be safely managed conservatively, but due to high risk of these acute subdural haematoma changing into chronic subdural haematoma these patients should be reinvestigated in case of neurological deterioration.