Seroprevalence of transfusion transmitted infections among different blood group donors at blood bank LUMHS, Hyderabad

Objectives: To study the prevalence of HBsAg, Anti-HCV, HIV, Syphilis and Malaria in blood donors

Methods: This is a cross sectional descriptive study, conducted at Blood bank and Transfusion center at Liaquat University of Medical and Health Sciences [LUMHS] Hyderabad, during the period from January, 2014 to June, 2015.A total of 4683 blood donors were screened for HBsAg, Anti-HCV and HIV on Architect 20001 [manufactured by Abbott], employing chemiluminescent microparticle immunoassay [CMIA]. For Syphilis, VDRL ICT kits were used and Malaria parasite was screen through MP slides. Blood grouping was performed by both forward and reverse methods

Results: This study showed a high frequency of HBsAg, VDRL and malaria positivity among the O-ve blood group donors, i.e. 3.70%, 9.25% and 0.61% respectively. Blood group B-ve individuals were commonly infected with HCV [12.5%] as compared with all other blood group donors. HIV is more commonly reported in A+ve blood group individuals. Blood group O+ve is more prevalent [37.41 %]

Conclusion: High frequency of HCV infection in blood donors advocates implementation of strict screening policy for donors and public awareness campaigns about preventive measures to reduce the spread of this infection as well as other transfusion transmissible infections

Serum cobalamin and dyslipidemia in type 2 diabetics

OBJECTIVE: To evaluate serum cobalamin with special reference to dyslipidemia in type 2 Diabetic subjects

STUDY DESIGN: Observational study

PLACE AND DURATION: Department of Medicine, Isra University Hospital and Consultant Clinics Hyderabad, Sindh from January 2014 to July 2014

METHODOLOGY: A sample of 107 type 2 diabetic subjects was selected according to inclusion and exclusion criteria. Cobalamin was measured on Roche Cobas e411 chemistry analyzer and blood lipoproteins by standard laboratory methods. Data was analyzed by SPSS version 21.0 using appropriate statistical test. P-value of

RESULTS: Cobalamin deficiency was noted in 51 [47.6%] of diabetics which has associated with dyslipidemia. Mean +/- SD of serum cobalamin in normal and reduced serum cobalamin groups were noted as 355+/-29.5 and 183+/-17.5 pg/ml respectively [p=0.0001]. Triglycerides, total cholesterol, HDLc, LDLc and VLDLc differed significantly in the normal and reduced cobalamin subjects

Lipoprotein sub fractions showed a negative correlation with serum cobalamin

CONCLUSION: Cobalamin deficiency is common in type 2 diabetics associated with dyslipidemia

Laparoscopic cholecystectomy in acute gallstone pancreatitis in index hospital admission: Feasibility and safety

Acute gallstone pancreatitis is quite common throughout the globe. Conventionally definitive cholecystectomy has been delayed in index hospital admission. Since the last decade timing of cholecystectomy is gradually shifting towards the earlier phase of disease and currently gallstone pancreatitis is being evaluated as a further indication for laparoscopic cholecystectomy. There is also great concern regarding compliance of patients for definitive surgery due to poverty, ignorance and illiteracy in developing countries. The aim of this study was to assess the feasibility and safety of laparoscopic cholecystectomy as a definitive treatment in patients with mild and resolving gall stone pancreatitis. This was a prospective study from July 2009 to June 2012. Patients were diagnosed by clinical examination, biochemical tests, ultrasonography and contrast enhanced CT. Patients with mild form of the disease [Ranson Score <3] and who showed clinical improvement were offered laparoscopic cholecystectomy in index hospital admission. Those who were unfit for surgery were referred for endoscopic sphincterotomy. Common bile duct stones were excluded preoperatively. A total of 38 patients were admitted with acute gallstone pancreatitis in the study period. The mean age of patients was 46.3 years with male to female ratio of 11727. 22 [57.8%] patients were selected for laparoscopic cholecystectomy and procedure was completed successfully. Ten [26.3%] patients were referred for ERCP and endoscopic sphincterotomy and 11 [28.9%] were managed by conservative treatment and went without any definitive treatment. Mean duration of time from onset of symptoms and laparoscopic cholecystectomy was 7 days [range 4-10]. Mean duration of operative time was 45 minutes and hospital stay was 7 days. There was no operative mortality. No major intra-operative or post-operative complication was recorded, two patients [9%] had minor complications. Laparoscopic cholecystectomy can be safely performed in selected cases of mild gallstone pancreatitis in order to prevent further attacks of acute pancreatitis and Other consequences Of d6l3y8[] treatment. Furthermore it resolves the problem of noncompliance of patients in third world countries where many patients are lost for definitive treatment

Unusual histopathological findings of appendectomy specimens

Background: Appendicitis is a very common surgical clinical condition and appendectomy is a frequently performed procedure worldwide. Although obstruction caused by fecoliths or lymphoid aggregation is a common reason for appendicitis, unusual histopathological findings can be a cause too. Unusual findings can range from benign conditions like worm infestation and cysts to malignant conditions like carcinoid tumors and adenocarcinomas. Enterobius vermicularis infection, tuberculosis, ascaris lumbricoides infestation, carcinoid tumors and cystadenomas are some of the commonly appearing unusual findings

Objective: To document the number of rare histopathological findings of appendectomy specimens

Methods: A 7 year retrospective study was conducted at Ziauddin University Hospital from March 2005 to December 2012. From accumulated information for 2157 appendectomies, 138 appendectomy specimens had rare histopathological findings. Incidental and negative appendectomies were excluded from this study

Results: 58% of the patients with unusual histopathological findings were males [n=80] and 42% were females [n=58]. Most common findings included: Enterobius vermicularis48.5% [n=67], Tuberculosis13% [n=18], Carcinoid tumors 9% [n=13] and cystadenomas 8% [n=11]. Other findings include: peri appendicular abscess, adenocarcinoma of colonic origin, necrotizing lymphadenitis, ascaris lumbroides, Meckel's diverticulum, taenia saginata, pheochromocytoma and mucocele

Conclusion: Appendectomy specimens should be routinely sent for histopathological examinations as this practice can help in diagnosing rare tumors and conditions

Carcinoid tumors: an ignored cause of appendicitis

Background: Many conditions related to appendix present as appendicitis. These conditions can range from fecolith obstruction to tumors .Carcinoid tumors are most common tumors to present in appendix. Most of the carcinoid tumors in appendix present as appendicitis. Majority of the cases are diagnosed after histopathological examination, with 90% of the tumors measuring smaller than 1 cm with excellent prognosis after appendectomies. Tumors with the size of 2cm are treated with right hemicolectomy

Objective: To determine the frequency of carcinoid tumors in appendectomies using histopathological data

Methods: This was a retrospective study conducted at Ziauddin University Hospital, Nazimabad for a time period of 7 years from March 2005 to December 2012. 2,157 appendectomies were analyzed, out of which 13 appendectomy specimens were diagnosed as carcinoid tumors. Incidental and negative appendectomies were excluded from this study

Results: 0.60% of the appendectomy specimens were diagnosed as carcinoid tumors [n=13], male to female ratio was [5.5:1], 77% [n=10] of the tumors were up to 1 cm in size and 23% [n=3] of the tumors were of 1.5 cm in size. Majority of the tumors [n=9] had well differentiated cell types. 77% of the tumors were localized to the tip of the appendix, 15% of the tumors spread locally to the distal half of the appendix and 8% spread to the mesentery

Conclusion: Carcinoid tumors of the appendix, mostly present as appendicitis in early stage. While 90% of the cases show excellent prognosis with appendectomy, 10% of the cases might need further management

Vitamin B[12] deficiency with megaloblastic anemia: an experience at tertiary care hospital of Sindh

OBJECTIVE: To determine frequency of Vitamin B12 deficiency in subjects with anemia and elevated mean corpuscular volume

STUDY DESIGN: Cross sectional study

PLACE AND DURATION: Department of Medicine, Liaquat University and Isra University Hospital Hyderabad from January 2011 to August 2013

METHODOLOGY: A sample of 113 subjects was selected according to inclusion and exclusion criteria. Serum vitamin B12 deficiency was defined as per standard criteria. Blood samples were analyzed on Sysmex KX 21 hematology analyzer. Continous variables were analyzed by ANOVA and Tukey-Cramer test while categorical variables by Chi-square test

The association between variables was analyzed by Pearson`s correlation. A p-value of

RESULTS: Of 113 subjects, 37 [32.7%] were male and 76 [67.2%] female, mean+/-SD age was 34.48+/-6.71 years and 89.3% [n=101] were anemic. Mean hemoglobin, hematocrit and RBC counts were found as 11.3 g/dl, 33.1% and 3.0 million/µL respectively. Of total 113 subjects, vitamin B[12] deficiency was noted in 65 [57.5%]; further subdivided as borderline and definitive deficiency in 19.4% and 37.9% respectively. Mean corpuscular volume as high as 139 fl and vitamin B[12] levels as low as <30pg/ml were found. Pancytopenia was noted in 11 [9.7%] with severe vitamin B[12] deficiency [<100pg/ml]. Significant negative correlation was found between vitamin B[12] and mean corpuscular volume [r=-0.79, p=0.0001]. Peripheral blood film revealed anisocytosis, poikilocytosis, megaloblasts and hypersegmented neutrophils

CONCLUSION: Vitamin B12 deficiency is prevailing and is a major contributing factor of megaloblastic anemia

Prediction of esophageal varices in cirrhotic patients with serum - ascites albumin gradient

OBJECTIVE: To identify commonest SAAG "serum-ascites albumin gradient" value in patients with cirrhotic disease having esophageal varices and to discover values of serum ascites and serum albumin

MATERIAL AND METHODS: This cross sectional was conducted on 100 cirrhotic patients with ascites to calculate SAAG level in serum and ascitis fluid the value of SAAG was examined [>/=1.1 g/dl] and high SAAG was measured to be >/=1.1 g/dl and Low SAAG when it is <1.1g/dl to rank the esophageal varices. All the cases included in the study under went upper GI endoscopy

RESULTS: From total 100 patients, male were 62 and female were 38. SAAG was 2.01 +/- 0.52. Esophageal varices [EV] found in 87 patients and were absent in 13 patients. Grades of the esophageal varices highlighted significant correlation with degree of SAAG [p<0.01] with r =0.55 [p<0.01] of Pearson correlation coefficient. With uses of ROC curve a SAAG value i.e. >/=1.65 +/- 0.014 g/dl was an correct marker of the occurrence of EV; cutoff points for the higher predictive value 98% were positive, and 96% were nagetive

CONCLUSION: In the cirrhotic patients having ascites, the occurrence of EV is related only with SAAG and size of EV are mainly associated to the degree of SAAG. A SAAG value of >/=1.65 +/- 0.014 g/dl is a helpful mean to predict the occurrence of EV in cirrhotic patients with ascites

Fistula in ANO; presentation and postoperative outcome of the different surgical procedures in low type

This study was planned to find out the clinical presentation and postoperative outcome of different surgical procedure in low type in low fistula in Ano. Prospective observational study. Study was conducted in teaching hospital setting at LUMHS Jamshoro, Zia ud Din Teaching Hospital Karachi and DHQ JMC Teaching Hospital Charsadda. Liaquat University in Surgical Unit-1 Jamshoro from May 2010 to June 2012. One seventy cases of low type fistula in Ano with single external opening, irrespective of age and sex admitted in surgical unit-l, were examined. Mean age was 37 years, patient's rages from [15-60 years]. Patients having high type fistula in ano identified pre and per operatively excluded from the study. A detailed history physical examination including local examination of anorectum focusing on the level of internal opening. Investigation like fistulogram done in selected case. Fistulectomy and fistulotomy performed in all these cases and patient followed up minimum upto the 6 months time. Maximum Number of cases were seen in 3rd,4th, decade of life 50 [29.6%] and 64 [37%] respectively. Mean age was 37 ranges from 15 to 60 years. Out of 172 patients 142 [85.7%] male and 24 [14.3%] female. Male to female ratio was 6.1:1. Majority of patients one forty two [82%] presented with discharge. Discharge along with swelling in 132 [76.7%]. Hundred twelve [65%] underwent fistulectomy, 38 [22%] of the patients got fistulotomy and [12%] of patients underwent fistulectomy along with haemorrhoidectomy and fissurectomy. A total of 72 [41.4%] patients experience different post operative, surgical and anesthetic complications. Conclusions: Incidence of low type fistula in ano is higher in 3rd and 4th decade of life. The disease was found more common in male, discharge, pain, itching are common symptoms of low type fistula in ano. In low type fistula in ano fistulotomy is safe procedure. Post operative complications can be prevented by careful treatment efforts

Biliary bypass surgery - Analysis of indications and outcome of different procedures

This study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years. This is a prospective observational study conducted over a period of 10 years [January 2001-december 2010]. A total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct [CBD] stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, CBD strictures and cases who developed iatrogenic biliary injuries during cholecystectomy [both open and laproscopic] during this period of time. The patients who required biliary bypass surgery were further analysed for indications and outcome. Out of 1500 patients 83 [5.53%] required biliary bypass surgical procedures. The CBD stones were observed as the most common indication [25.3%], followed by CBD injuries after open [10.84%] or laproscopic-cholecystectomy [14.46%], carcinoma head of pancreas [12.05%] and CBD obstruction [14.46%] either due to CBD strictures or unknown distal obstruction. Roux-en-Y-hepatico-jejunostomy [26.51%] was the most frequently performed procedure, followed by choledochoduodenostomy and Roux-en-Y choledocho-jejunostomy [i.e. 25.3% and 12.05% respectively]. Roux-en-Y biliary bypass procedure was observed to be associated with better outcome in terms of rate of complications as well duration of hospital stay. Biliary bypass surgical procedures are the better options to restore the continuity of biliary system in patients with iatrogenic biliary tree injuries and un-operable pancreatico-biliary malignancy. Roux-en-Y biliary bypass procedure is safe and problem solving method in these cases

Comparative study of conventional open versus laparoscopic cholecystectomy for symptomatic cholelithiasis

To compare the results of conventional open with laparoscopic cholecystectomy regarding their operative time and postoperative parameters. This is a comparative study of 400 patients of cholelithiasis operated for either open or Laparoscopic cholecystectomy during five years from January 2004 to December 2008. The cases were compared for operative time and various postoperative parameters in order to assess the advantages and disadvantages of each procedure. The patients were divided into two groups; group OC for open and group LC for laparoscopic cholecystectomy, each comprising of 200 cases. The operative time was longer in OC than LC patients with mean operative time of 54.16 +/- 11.94 minutes in OC and 46.89 +/- 14.83 minutes in LC group [P<0.001]. The overall frequency of postoperative complications was relatively high in OC group 50.5% as compared to LC [37%] including all minor and major problems with combined morbidity of 43.75% [P<0.001]. The mean hospital stay was shorter in LC group as compared to OC group i.e. 3.02 +/- 1.75 [range 1-5] days versus 5.56 +/- 9.8 [range 4-10] days respectively. Return to normal work was also significantly shorter in LC group i.e. 18.06 +/- 5.16days [range 1-4 weeks] as compared to 31.61 +/- 7.6 days [range 3-6 weeks] in OC group with p value <0.001. The laparoscopic cholecystectomy is superior to open cholecystectomy due to short operative time, early mobilization and fast recovery, less postoperative pain and complications, short hospital stay and early return to work

Factors responsible for prolonged postoperative hospital stay after laparoscopic cholecystectomy

To identify various factors which prolong post-operative hospital stay after laparoscopic cholecystectomy. This is an observational prospective study conducted at a teaching hospital over a period of five years [Jan 2005-Dec 2010] and includes 580 patients of symptomatic cholelithiasis, admitted and treated by laparoscopic surgery. All patients were observed from 1st postoperative day to date of discharge and different operative, postoperative and patient related variables were recorded on a proforma which were found responsible for an unduly prolonged post-operative stay in the hospital. The duration decided for short stay was 48 hours and duration more than that was considered as prolonged stay. Out of 580 patients, 187 [32.24%] had prolonged stay extending from 3-28 days. Majority of patients presented in 4[th] and 5[th] decade [60.52%] with pain in right hypochondrium [58.79%] and pain in right hypochondrium combined with pain in epigastrium [27.6%] as main clinical features. Twenty eight variables were identified comprising of 10 patients related [15.86%], 12 surgery related [16.55%] and 6 post-surgery related [16.38%] which contributed to prolong the hospital stay. Patients having co morbid conditions, difficult operative procedure and major postoperative complications were main factors for prolonged stay. The prolonged post-operative hospital stay can be reduced by careful pre-operative assessment, meticulous surgery and proper post-operative management

Our experience of anesthetic management for separation of craniopagus conjoined twins

We describe the anesthetic/airway management for surgical operations in conjoined twins [Craniopagus] in Children Hospital, PIMS, Islamabad, in January 2011. The anesthetic technique and associated problems are summarized

Undetected common variable immune deficiency in a young adult of Pakistani descent

Common variable immune deficiency [CVID] is a syndrome which is due to deficiency of humoral immune response resulting in increased susceptibility to infections. We report a case of CVID in a 24-year-old male who presented with a history of recurrent pneumonias

Laparoscopic versus inguinal [Ivanissevich] varicocelectomy

To compare the postsurgical outcome of laparoscopic and open inguinal varicocelectomy. Quasi-experimental study. Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2003 to June 2007. One hundred seven patients underwent either open inguinal or laparoscopic varicocelectomy. Diagnosis was made by clinical examination and color Doppler scan in doubtful cases. Pre-operative semen analysis was done in all patients. Operative time, postoperative analgesic requirement in number of tablets, hospital stay in days, improvement in semen parameters in subfertile subjects, pain on visual analog score, and postoperative complications were recorded and compared between the two groups. There were 50 patients in each group, with age ranging from 12-50 years [26.9 +/- 7.67 in open inguinal and 26.2 +/- 7.08 in laparoscopic group]. Average operative time was 34.8 +/- 7.89 minutes for open inguinal and 43.8 +/- 8.95 minutes for laparoscopic group. The analgesic requirement was 16.3 +/- 1.58 tablets in the open inguinal and 11.3 +/- 2.23 in the laparoscopic group. Postoperative pain was significantly less in the laparoscopic group. There was statistically significant [p < 0.001] improvement in sperm count as well as motility in both groups irrespective of procedure. The open inguinal [Ivanissevich] procedure and laparoscopic varicocelectomy had almost equivalent postoperative outcomes regarding improvement in semen parameters and postoperative complications. Open inguinal procedure had a shorter operating time while laparoscopic varicocelectomy had the advantage of less analgesic requirement and short hospital stay. On the whole, open inguinal [loupe magnified] varicocelectomy is an effective procedure where availability and costs of laparoscopic instruments are barriers

Epidural tramadol and bupivacaine in obstetric patients with concurrent cardiac diseases

The physiological changes of pregnancy and the stress of labor put added strain on already small cardiac reserve of cardiac patient. Although minimal equipment and expertise is required for regional anesthesia, the sequel of sympathetic blockade does not make it an ideal choice for cardiac patient. The use of low concentration of local analgesic agent with the addition of opioids helps keeping the cardiovascular system stabilized. We used injection tramadol with bupivacaine to study the haemodynamic stability in the obstetric cardiac patients requiring epidural analgesia. To determine the haemodynamic stability in cardiac patients during caesarian delivery under epidural analgesia with low dose bupivacaine and tramadol. A descriptive. This study was conducted in Mother and Child Health Center, Pakistan Institute of Medical Sciences, Islamabad from March 2006 till June 2008. A total of thirty patients suffering from either rheumatic heart disease, cardiomyopathies or ventricular septal defect were given epidural aesthesia. Intra operative hemodynamic parameters were recorded after every three minutes, and the data were analyzed. Thirty patients were studied. During epidural anaesthesia heart rate mean + SD was 05 + 15, systolic Blood pressure 110 + 10.3 and diastolic blood pressure at 65+ 4.3. Epidural anaesthesia with bupivacaine and tramadol not only provides excellent analgesia to the cardiac patients for caesarian section but also keep their haemodynamic status near to their pre operative levels

Antigravity lift technique is helpful in difficult intubation in patients with large goiters

A 45 years old female with huge goiter presented for thyroidectomy. She had history of snoring and dysnea, airway evaluation revealed Mallampatti 2, IIG 3F, but temporomendibular distance [TMD] and sternomendibular distance [SMD] were impossible to measure due to grossly enlarged thyroid. Radiological examination revealed displacement of trachea towards right. After induction and depolarizer relaxation laryngoscopy was performed and Cormack Lehane 4, POGO zero was observed. With our technique of antigravity lifting, vocal cords were visualized making intubation possible with endotracheal tube on stylet

Frequency of peripheral arterial disease in diabetic foot

Objective: to determine the frequency of peripheral arterial disease in patients with diabetic foot

Study design: prospective descriptive study

Place and duration: this study was conducted at Medical Unit-IV Liaquat University Hospital, Jamshoro/Hyderabad from February 2007 to August 2008

Patients and methods: diabetic patients with non-healing foot ulcer, were selected for the study by non-probability purposive sampling technique. Ankle brachial index [ABI] was calculated; peripheral arterial disease [PAD] was diagnosed when ankle brachial index was less than 0.9 and further graded as mild, moderate and severe as per recommendations of American Diabetes Association. Frequencies with proportions in different grades were calculated

Results: a total of 67 diabetic foot patients were included, amongst which 51 [76.1%] were males and 16 [23.9%] were females. Peripheral arterial disease was found in 30 [44.78%] patients, among them 18 [60%] had mild, 12 [40%] had moderate and none had severe peripheral arterial disease

Conclusion: ankle brachial index [ABI] is a simple and cheap technique for the diagnosis of peripheral arterial disease [PAD]. The PAD is one of the major risk factors for diabetic foot, which can be prevented by monitoring ABI in at-risk patients

Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children with hypospadias repair

To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with hypospadias repair. Randomized controlled trial. The Department of Paediatric Anaesthesia, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, from April to September 2006. Sixty children aged between 13-53 months coming for hypospadias repair were divided randomly into two groups A and B. A caudal block was performed immediately after induction of general anaesthesia. The patients in group A received 0.125% bupivacaine 1 ml/kg with tramadol 1 mg/kg body weight caudally. Group B patients received 0.25% bupivacaine 1 ml/kg body weight caudally. Anaesthesia was discontinued after completion of surgery. In the recovery area, ventilatory frequency and pain scores were recorded at 1 hourly interval for first 6 hours and then every 2 hours for next 6 hours postoperatively. A modified TPPPS [Toddler-Preschool Postoperative Pain Scale] was used to assess the pain. Episodes of vomiting, facial flush and pruritus were noted, if present. The duration of analgesia was significantly prolonged in group A patients [p-value=0.001]. A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group A and 6.66% in group B [p-value=0.64]. No respiratory depression, flushing and pruritus were observed. Low dose combination of bupivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects. The risk of toxicity from bupivacaine decreased when combined with tramadol in low doses

Frequency of thyroid disorders during interferon and ribavirin therapy in chronic hepatitis C infection

The objective of this study was to assess the frequency of thyroid dysfunction in response to combination of interferon and ribavirin therapy in chronic hepatitis C [CHC] patients and HCV outcome. Descriptive study. This study was conducted at Outpatient Department of Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad from September 2005 to September 2007. One hundred cases of CHC, proven by anti-HCV and HCV RNA-positive with baseline TSH, FT[4] and FT[3] within the normal reference range, who were treated with interferon alpha-2b [3 million unit subcutaneously three times per week] and oral ribavirin [1000-1200 mg per day] were included in this study. All patients were assessed for TSH, FT[4], FT[3] levels at 12 weeks and 24 weeks during therapy. Among the 100 patients, overt thyroid disease developed in 13 [13%] and sub-clinical thyroid disease in 5 [5%]. Out of 13 patients of overt thyroid disorders, 11 [84.6%] had hypothyroidism and 02 [15.3%] hyperthyroidism. Four [80%] patients were of sub-clinical hypothyroidism and 01 [20%] patient was of sub-clinical hyperthyroidism. Overall, thyroid disorders developed in 18 [18%] both as overt and sub-clinical thyroid disorders. Ninety one [91%] patients became negative by HCV RNA. Treatment of HCV with IFN-alpha and ribavirin can be safely continued in patients with over and sub clinical hypothyroidism because thyroid disease responds well to treatment