Percutaneous endoscopic gastrostomy: Nine years experience in a tertiary care centre in Pakistan

To review the experience of percutaneous endoscopic gastrostomy [PEG] tube placement and its management in the last nine years, at a tertiary care center in Pakistan. All patients who underwent percutaneous endoscopic gastrostomy from January 1995 to January 2004 at Shifa International Hospital, Islamabad, were included in this study. The indications, technique, complications and follow up were reviewed. A total of 182 persons underwent this procedure. There were 118 [65.0%] males and 64 [35.0%] females. Age ranged from 55-86 years. One hundred seventy five [96.0%] patients had cerebro-vascular accident, five [2.75%] had Parkinson's disease and two [1.25%] malignancy. More than 99% procedures were successful and no procedure related mortality was noted. Mild PEG site infections were encountered in eighteen [9.8%] patients which were manageable with local treatment and oral antibiotics. Four [2.2%] patients had severe tube site infection and needed parenteral antibiotics. Tube dislodgement took place in five [2.75%] patients and had to be removed and reinserted. Thirty days follow up was uneventful with regard to the tube. Longest follow up was 736 days. Percutaneous endoscopic gastrostomy had proved a viable means of enteral nutrition in patients with neurological impairment. Complications were insignificant. However, patient and care giver's education could be improved for more effective tube management, and prevention of PEG insertion site infection

Treatment outcomes with long acting octreotide in inoperable hepatocellular carcinoma: a local experience and review of literature

To determine the efficacy of long acting octreotide [LAP] in the treatment of inoperable hepatocellular carcinoma; as well as to estimate the improvement in the quality of life. This study was carried out at the Shifa International Hospital, Islamabad between February and September 2003. Patients were recruited after an informed consent. There were 22 patients who decided to take the medication whereas 20 patients refused due to socio-economic issues. They served as controls.The patients agreeable for treatment were administered octreotide 100 meg subcutaneously thrice daily for two weeks. This was followed by monthly administration of 20 mg intramuscular octreotide. The patients were followed up for 6 months. Tumor size, alpha-fetoprotein levels, and improvement in quality of life [QOL] were monitored during therapy. Out of 22 patients, 19 patients completed the treatment. All were males. Mean age at presentation was 55 years. Tumor size regression was seen in 10 out of 22 patients [45.5%]. Mean alpha-fetoprotein levels decreased in 11 out of 22 [50%] patients. An improvement in the quality of life was seen in 10 out of 22 [45.5%] patients after treatment with long acting octreotide. In the treatment arm, 14 out of 22 [64%] patients were alive at the end of six months as compared to 10 out of 20 [50%] in the control group. LAR causes tumor size regression, decreases AFP levels and improves quality of life in patients with inoperable hepatocellular carcinoma

Successful treatment of resistant chronic hepatitis C virus infection with high dose pegylated interferon

We present the case of a 49 years old male, who was HCV RNA positive with an ALT of 260, showing no response to standard interferon [INF] plus ribavirin treatment for 48 weeks and to a further therapy with high dose standard IFN plus ribavirin for 24 weeks. Pegylated [PEG] IFN was then started at a dose of 80mcg/week with ribavirin, but proved to be of no avail. Finally, a dose of 120mcg/week of PEG INF and ribavirin was administered for 48 weeks. This resulted in negative HCV RNA PCR after two months and remained undetectable with normal ALT. A six-month follow-up showed a sustained viral response

Interspousal transmission of hepatitis C VIRUS

To estimate the sero-prevalence of anti-HCV among the spouses of HCV positive patients. A cross-sectional survey. Shifa International Hospital, Islamabad, from January 2001 to January 2004. Spouses of patients of hepatitis C were studied. Spouses of patients who had hepatitis C by the presence of anti-HCV and HCV RNA [PCR] were tested for anti-HCV by ELISA method. A total of 347 consecutive patients were included in the study. Fifty-three patients were single, 48 were widows or divorced and 19 individuals refused to be tested. Thus, 227 patients were available for anti-HCV testing. Out of these 227 spouses tested, 10 [4.4%] were found to be positive for anti-HCV. The mean age of HCV-positive spouses was 44.2 +/- 8.31 years, while that of HCV-negative spouses was 46.37 +/- 11.31 years [p=0.55]. The mean years of marriage of HCVpositive spouses was 20.1 +/- 9.79 years as compared to 21.1 +/- 9.96 years for HCV-negative spouses [p=0.75]. The male proportion of HCV-positive spouses was 60% as compared to 57.6% for HCV-negative spouses [p=0.9]. The patients and spouses had common risk factor of history of injections. A positive anti-HCV was found in 4.4% spouses and common risk factors of history of injection and transfusion were noted in the patients and spouses

Treatment of chronic hepatitis B with lamivudine

To study the efficacy of antiviral drug lamivudine for treatment of chronic hepatitis B in Pakistani population. Experimental study. A tertiary Care Center, from January 2000 to January 2004. Patients who had positive hepatitis B surface antigen [HBsAg] and elevated ALT were recruited. Both hepatitis Be antigen [HBeAg] positive and HBeAg negative patients were included. Treatment was given with lamivudine 100mg once a day for 12 months and they were followed every 2-3 months with ALT, HBeAg, and in certain cases with, HBV DNA [PCR]. Those patients who were HBeAg positive were considered to have achieved end of treatment response [ETR] when ALT was normal and HBeAg was negative and this was documented at two consecutive occasions, at least one month apart. Those patients who were HBeAg negative were considered to have achieved ETR when their ALT was normal and HBV DNA was undetectable. Patients were followed for further 6 months to evaluate for any relapse. A total of 105 patients were included. Eighty-two [78.1%] were males and 23 [21.9%] were females. Mean ALT of all patients was 87.15 +/- 46.01 u/dl. Seventy-two HBeAg positive and 15 HBeAg negative patients completed treatment with 23.6% and 80.0% response rate respectively [p <0.001]. The response of lamivudine in chronic hepatitis B in Pakistani population is encouraging in HBeAg negative patients but is rather low in those who are HBeAg positive

General seroprevalence of hepatitis C and hepatitis B virus infections in population

To determine the prevalence of hepatitis C virus [HCV] and hepatitis B virus [HBV] infection by detection of anti-HCV and hepatitis B surface antigen [HbsAg] in general population of Pakistan. Design: Observational. Place and Duration of Study: Community clinic of Shifa International Hospital, Islamabad, from January 1998 to June 2004. Materials and Sera of healthy adult individuals who presented for medical evaluation as a pre-employment criteria in the Gulf region were examined for presence of hepatitis B surface antigen and anti-HCV antibody. Alanine aminotransferase levels were also determined. A total of 47,538 individuals were examined. Out of these, 2528 [5.31%] were positive for anti-HCV and 1221 [2.56%] individuals had positive HBsAg. Hepatitis B surface antigen and anti-HCV both were found in 92 [0.19%] individuals. Mean age of subjects, positive for HCV antibody was 44 years and 40.5 years for HBV. Ninety-four% individuals were males and 6% were females. Alanine aminotransferase [ALT] was normal in 56% of subjects with positive HCV and 84% of individuals with HBV. This study which evaluated predominantly a healthy male population, showed a high seroprevalence of anti-HCV and average seroprevalence of hepatitis B virus infection. A large majority of these patients was young and had normal ALT