Pharmacoeconomic analysis of treatment of patients infected with hepatitis C virus

Hepatitis C infection imposes a high economic burden globally. It has been estimated that in 2012, the healthcare cost of Hepatitis C virus [HCV] was dollars6.5 billion. Furthermore, it has been projected that the cost will reach at 9.1 billion dollars by the year 2024.Frequency of hepatitis C in Pakistan is significantly higher [4.5%] when compared to the populations like India [0.7%], Nepal [1.0], Myanmar [2.5%], Iran [0.8%], China [1%] and Afghanistan [1.1%]. The current standard of care for chronic infection with hepatitis C virus is 24 or 48 weeks of therapy with Pegylated interferon-alfa-2a [Peg INF] +Ribavirin [RV] or Interferon alfa-2a [INF] + RV. The objective of this study was to determine that which combination is more effective and the gain in sustained virologic response [SVR] is worth the incremental cost. In total 84 patients were enrolled who received current standard treatment of care for chronic infection with HCV either 24 or 48 weeks of therapy with Peg INF + RV or INF + RV. A pharmacoeconomic analysis was done including fixed and variable cost [comprising concomitant therapies, emergency visits and hospital admissions] of both treatment regimens were calculated and compared with the SVR accomplished by the patients. It was concluded that the Peg INF + RV is cost effective as compared with conventional INF + RV for the treatment of adult patients infected with HCV genotype 3a under a varied array of possibilities regarding treatment costs and effectiveness

Diverse pharmacological properties of Cinnamomum cassia: a review

Cinnamomum cassia is widely utilized as a spice in different cookeries worldwide, especially in Asian cuisines. This herb is also being used in different forms of traditional medicine [Unani, Ayurvedic, Japanese and Chinese] for managing conditions like dyspepsia, peptic ulcer disease and ischemic brain injury. Recent studies have shown the scientific evidence for the medicinal use of this particular herb in several diseases like H. pylori infection, diabetes, brain ischemia and cancers. This article reviews the literature on potential benefits of the herb published within the last 10 years. The authors used Medical Subject Headings [MeSH] terms [Cinnamomum] with [cassia] or [arromaticum] to filter the PubMed database. To date, no systemic review focusing on medicinal use of C. cassia was found in the literature. Various research articles elucidating diverse pharmacological properties of C. cassia were identified. The standardised extract of C. cassia or the active compounds extracted from the herb might prove to be a novel candidate for early prevention and complimentary management of conditions like diabetes mellitus or H. Pylori-associated disorders

Diabetic control situation; a study of diabetic patients in ministry of health primary health centers of Makkah Al Mukkarahma Saudi Arabia

To determine the prevalence of controlled diabetes in registered diabetic patients with Hemoglobin A1c [HbA1c]

Serum levels of estradiol in women with carcinoma of the breast and its correlation with body mass index

Background: carcinoma of the breast is a disease of complex etiology and is discussed in terms of risk factors which include increasing age, increased exposure to estrogen, over weight and obesity etc; Efforts are being made to get more al]d more insight of the· etiology to decrease its occurrence, for early diagnosis and to have good prognosis. The main objective of the study was to determi11e the serum levels of estradiol and to assess· its correlation "with body mass index [BMI >25 kg/m2] in female patients with carcinoma of the breast and healthy over-weight and obese females

Material and Methods: serum levels of 3ffconfrofs-[healthy] and 60 cases [Carcinoma of the breast females] were analyzed for Estradiol and were correlated with their BMI. Levels were estimated by Enzyme linked immunosorbent assay [ELIS4] and correlation was calculated by regression analysis and correlation coefficient

Result: overall trend of obesity was observed in cases [patients with carcinoma of the breast]. Serum estradiol leye3fs showed strong correlation with BMI in' both cases [p=0.11] and control [p=0.002]

Conclusion: it is concluded that obesity remains an important risk factor for carcinoma of the Breast.-Serum estradiol levels are strongly associated with Body Mass Index

Results of primary closure in the management of gangrenous and viable sigmoid volvulus

To compare the outcome of primary repair, both in viable and gangrenous cases of Sigmoid Volvulus. Retrospective study conducted from August 2001 to April 2006. District Headquarter Hospital, Bannu, North West Frontier Province. All patients admitted with large gut obstruction due to Sigmoid Volvulus. After initial investigations and resuscitation, the patients were shifted to the operation theatre where the vascular status of the sigmoid colon was noted, and resection and primary anastomosis was done in all the cases. Patients were allowed orally after 3-5 days, when their bowel sounds returned and they were able to pass flatus and/ or faeces. All patients were discharged home after recovery, and were followed up for a minimum of four months. The outcome of both the gangrenous and the viable gut patients was compared in terms of anastomotic leakage, wound infection, hospital stay and long term complications. The findings were entered onto a proforma and the results compiled and analyzed. Amongst the total 83 patients, there were 72 [86.7%] males and 11[13.3%] females, with an age range of 35-80 years [mean 55 years]. All patients presented with the typical symptoms of intestinal obstruction. Local and systemic signs of toxicity were more common in the gangrenous group. Postoperatively 17 [53.12%] patients in the gangrenous group and 9 [17.64%] cases in the viable group developed paralytic ileus; 2 [6.25%] patients in the gangrenous group developed anastomotic leakage leading to peritonitis; 2 [6.25%] patients in the gangrenous group and one [1.96%] in the viable group developed intra abdominal abscess; eight patients in the gangrenous group and five in the viable group developed wound infection, two of these patients late on developed incisional hernia. The mean hospital stay in the gangrenous group was 10 days as compared to eight days in the viable group. The difference in the outcome of primary anastomosis in both the viable and non viable groups was insignificant. Primary anastomosis can be safely done for acute sigmoid volvulus in both gangrenous and viable gut

Penetrating colonic injuries: management by primary repair

To assess the out come of primary repair in Penetrating Colonic Injuries. Prospective, interventional study from August 2001 to February 2004. Setting: This study was conducted at DHQ Hospital, Bannu. All patients who sustained colonic injury either by gunshot or stab injury were included in the study. Only those patients were included who were hemodynamically stable, did not have life threatening co-existing injuries and on operation were found to have mild to moderate peritoneal fecal contamination. All patients were operated after initial resuscitation and colonic injuries found were repaired primarily without fecal diversion. During the immediate and early postoperative period, these patients were observed for any complications like peritonitis, wound infection, peri-anastomotic abscess, pelvic, sub-diaphragmatic or interloop abscesses and colocutaneous fistulae. Patients were discharged home after they passed stools and their postoperative period remained uneventful for few days. Out of the 35 patients, majority were young males [80%]. The commonest mode of injury was fire arm, seen in 80% of the cases. The time interval between injury and repair was 4-12 hours [mean 6 hours]. Simple repair with interrupted suture was the commonest procedure performed, followed by right hemicolectomy. Twelve [34%] patients developed complications in the form of wound infection, intra abdominal abscesses and fecal fistulae. The total hospital stay was 7-21 days with the mean [9 +/- 2 days]. Primary anastomosis is safe and has excellent results in Penetrating Colonic Injuries

Experience of day care surgery at Peshawar

To evaluate the results of Day Care Surgery in our set-up. Retrospective study from Jan. 2003 to May 2005. Surgical 'C' Unit of Khyber Teaching Hospital, Peshawar. A total of 190 patients who underwent Day Care Surgery were included in this study. All patients were evaluated and counselled before hand, and asked to come on a given date. On the day of surgery they were shifted to the Operation Theatre, operated, kept under observation and sent home the same day with the advice to contact the concerned surgeon in case of any problem or complication. The patients were followed-up on the 3rd and 7th days, and examined for evidence of any local or distant complication. The patients were once again followed within a months time. Out of 190 patients, there were 131 male and 59 female patients, with an age range of two months to 65 years. All patients went home following surgery the same day except two, who were apprehensive and had to he kept for night. Twelve made telephone calls and were given advice. Five patients were readmitted with vomiting. two with severe pain and two with reactionary hemorrhage, and were discharged home the next day. One patient with hernia repair was readmitted after two days with scrotal oedema and treated. Day Care Surgery in uncomplicated cases is safe and cost effective. Majority of the patients were satisfied with this approach of early discharge