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

Mini Cholecystectomy -better option than conventional cholecystectomy

Cholecystectomy is the gold standard procedure for symptomatic gallstones. It can be performed by either open or by laparoscopic method. Open cholecystectomy can further be done by either conventional method or by using a smaller incision known as minicholecystectomy. Many studies previously have shown that minicholecystectomy has comparable results with laparoscopic or open cholecystectomy. This prospective study consisted of 100 patients and was done over a period of one year. Patients were randomly allocated as Group A [conventional cholecystectomy] and Group B [mini cholecystectomy]. The age and sex distribution were comparable. Minicholecystectomy was successfully performed in 46 [92%] of cases, while 4 [8%] cases were converted to conventional cholecystectomy. Ike total operative time was comparable in two groups. Moreover patients in Group B had less postoperative pain,,.shorter stay in hospital and returned early to their work. The postoperative complications were also comparable in both groups. This comparative study concluded that minicholecystectomy offer less postoperative pain, shorter hospitalization, and early return to work, without any increased risk of postoperative complications. Moreover it does not require sophisticated methods or additional specialized skills and thus can be performed by any experienced general surgeon

Post thyroidectomy hypocalcaemia - an audit of 100 cases

Purpose of our study is to compare the incidence of hypocalcaemia after total, near total or subtotal thyroidectomy for benign multinodular goitre. One hundred consecutive thyroidectomies performed for euthyroid benign multinodular goitre at West surgical unit, Mayo hospital, Lahore Pakistan, were included in the study. Mean age of patients was 33 [range 14 to 60] years. Preoperative serum calcium level ranged from 7.7 to 10.0 with an average of 8.8mg/dl. 34 patients had total thyroidectomy, 31 had near total thyroidectomy, 28 had subtotal thyroidectomy and 7 had lobectomy and isthmusectomy. Consultants performed 46 thyroidectomies, while senior registrars and residents performed 52 and 2 thyroidectomies respectively. 28 patients developed clinical features of hypocalcaemia.8 out of 31 patients who had near total thyroidectomy developed hypocalcaemia [25.8%]. Out of 34 total thyroidectomies, 11 patients had hypocalcaemia [32.3%]. In 28 patients who had subtotal thyroidectomy, 7 developed hypocalcaemia [25%]. 2 out of 7 lobectomy and isthmusectomy patients also required treatment for hypocalcaemia [28.5%]. Hypocalcaemia developed within 48 hours of surgery in 53% of our patients. Incidence of hypocalcaemia among patients operated by consultants was 23.9% [11 out of 46], while among patients operated by senior registrars and residents 17 out of 54 developed hypocalcaemia i.e. 31.5%. Average postoperative duration of hospital stay was 5.42 days in hypocalcaemic patients [range 2-17 days] and it was 2.77 days in normocalcaemic patients [range 1-6 days]. We conclude that post thyroidectomy hypocalcaemia is a complication with significant morbidity. The incidence of this complication can be reduced by meticulous surgical technique with special emphasis on haemostasis. Identification and preservation of well vascularized parathyroid glands must be attempted in every thyroidectomy

Effect of variable incubation temperatures and salt concentration on susceptibility testing of methicillin resistant staphylococcus aureus [MRSA]

The effect of variable incubation temperatures and variable salt concentration in the sensitivity agar on susceptibility testing of MRSA was evaluated. For this purpose 58 MRSA strains were tested. For each MRSA strain nine Mueller Hinton agar plates, three plates each with 2%, 5% and 7.5% sodium chloride [NaCl] supplement were inoculated. One plate from each of the salt concentration was incubated at 30°C, 37°C and 40°C. It was found that with increase in temperature of incubation the size of inhibition zones increased. In the presence of 2% NaCl supplement in the sensitivity agar, 5 MRSA appeared falsely intermediate sensitive on incubation at 40°C. While on incubation at 37°C although all MRSA remained methicillin resistant, statistical analysis revealed the effect on inhibition zone size to be approaching significance level [0.1 > P > 0.05]. The effect of incubation temperature on inhibition zone size was statistically insignificant [P>0.05] if 5% or 7.5% NaCl was incorporated in the sensitivity agar. Therefore we recommend the use of 5% NaCl supplemented sensitivity agar and incubation temperature of 37°C for the accurate detection of methicillin resistance in Staphylococcus au aureus