Pre-treatment predictors of response for assessing outcomes to standard treatment in infection with HCV genotype 3

To determine the role of pre-treatment predictors of response in assessing outcomes to standard treatment in HCV genotype 3. Observational study. Department of Medicine, KRL General Hospital, Islamabad, from December 2004 to December 2006. All patients with positive anti-HCV and PCR genotype 3a were recruited and written and informed consent was taken. Patients were treated with standard Interferon plus Ribavirin therapy [IFN alpha-2a, 3MU t.i.w 24 weeks plus Ribavirin 1000-1200 mg/day] for 6 months. The effect of pre-treatment factors influencing outcome i.e. age, gender, weight, baseline ALT, necroinflammatory grade, fibrosis and steatosis on the final outcome were further analyzed by univariate logistic regression analysis. Response rates to standard Interferon plus Ribazole therapy were studied in 190 patients. The end-of-treatment complete response [EOTCR] was seen in 81% [n=155] of the patients, whereas 17% [n=33] were non-responders [NR]. Sustained viral response [SVR] was seen in 58% [n=112] patients and 24% [n=45] were relapsers. SVR was higher in patients without steatosis [OR = 2.52, 95% CI = 1.356-4.71, p = 0.04]. Higher SVR was seen in patients weighing less than 65 kg, as compared with weight > 65 kg [OR= 2.277, 95% CI = 1.246-4.161, p = 0.007]. The other variables were not found to be significantly associated with improved SVRs. Out of the studied predictors, body weight and presence of steatosis, were statistically related to treatment outcome. Pre-treatment host factors can predict response to treatment that can help in individualizing treatment and patient selection and optimize treatment outcomes

Safety and efficacy of ureteroscopic pneumatic lithotripsy

To determine the safety and efficacy of ureteroscopic pneumatic lithotripsy [PL] for the clearance of ureteral calculi [UC]. Experimental study. Department of Urology, KRL Hospital, Islamabad, from March 2006 till December 2008. Ureteroscopic PL was performed on 104 patients with ureteric calculus measuring >/= 6 mm; using Swiss Lithoclast through a 9.5 French semi-rigid ureteroscope. At the end of the procedure, a DJ stent was inserted. Complications were noted. Stone clearance was assessed through X-ray KUB. DJ stent was removed within 3 - 6 weeks after the procedure. Sixty-eight patients [65.4%] were males and 36 [34.6%] females. The average hospital stay was 2.6 +/- 2.8 days; 72 [69.6%] patients were discharged on the first post-procedure day. Complete stone clearance was achieved in 98 [94.2%] patients, at 3-6 weeks. Four patients [26.7% of upper ureteral stones] had stone retropulsion. The only major complication was perforation occurring in 2 [1.9%] distal ureters. One case was successfully managed by endoscopic DJ stent placement, the other required open repair. Ureteroscopic PL is effective in clearing majority of middle and distal UC. Patients with proximal stones may have stone retropulsion. Ureteric perforation is an uncommon complication