Initial results of efficacy and safety of sofosbuvir among Pakistani population: a real life trialhepatitis eradication accuracy trial of sofosbuvir [HEATS]

Objective: The uridine nucleotide analogue sofosbuvir is a selective inhibitor of hepatitis C virus [HCV] NS5B polymerase approved for the treatment of chronic HCV infection with genotypes 1 - 4. The objective of the study was to evaluate the interim results of efficacy and safety of regimens containing Sofosbuvir [Zoval] among Pakistani population with the rapid virologic response [RVR2/4 weeks] with HCV infections

Methods: This is a multicenter open label prospective observational study. Patients suffering from chronic Hepatitis C infection received Sofosbuvir [Zoval] 400 mg plus ribavirin [with or without peg interferon] for 12/24 weeks. The interim results of this study were rapid virological response on week 4. Data was analyzed using SPSS version 21 for descriptive statistics

Results: A total of 573 patients with HCV infection were included in the study. The mean age of patients was 46.07 +/- 11.41 years. Out of 573 patients 535 [93.3%] were treatment naive, 26 [4.5%] were relapser, 7 [1.2%] were non-responders and 5 [1.0%] were partial responders. A rapid virologic response was reported in 563[98.2%] of patients with HCV infection after four weeks of treatment. The treatment was generally well tolerated

Conclusion: Sofosbuvir [Zoval] is effective and well tolerated in combination with ribavirin in HCV infected patients

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

Hepatotoxicity; preventive and therapeutic role of dexamethasone in LPS/Endotoxin induced

Background of Study: Sepsis is characterized by overwhelming surge of cytokines and oxidative stress to one of many factors, gram negative bacteria being one of it. Mortality remains very high in septic patients despite the advanced treatments rendered in intensive care units due to multiple organ damage including hepatotoxicity

Study Design: Randomized controlled laboratory trial

Period: 04 months from March 2014-June 2014. Setting: Department of Pharmacology and Therapeutics, Army Medical College, NUST, Rawalpindi

Aim of the Study: The present study was undertaken to learn dexamethasone's competence in prevention and treatment of LPS/ endotoxin induced hepatotoxicity in mice

Material and Methods: Endotoxin induced hepatotoxicity was reproduced via LPS of serotype E.Coli O111:B4 administrationintraperitoneally at a dose of 10mg/kg and all mice were sacrificed 17 hours latters. Dexamethasone [3mg/kg of b.w. i.p] was given 30 minutes before LPS in separate set of animals to determine its preventive role. Whereas therapeutic efficacy was adjudged by giving dexamethasone 2 hour after LPS administration. Hepatotoxicity was determined by estimation of serum ALT and AST and histopathological analysis of liver sections

Results: LPS administration was associated by statistically elevated serum ALT and AST and marked hepatic inflammation. Dexamethasone was efficacious in a version of LPS induced hepatic dystrophy both when given as pre and post-treatment. Serum ALT and AST were statistically lower when compared to LPS group. Also hepatic inflammation was statistically lessened by dexamethasone

Conclusion: Low dose dexamethasone has beneficial role in reduction of LPS/endotoxin induced hepatic injury in experimental model of sepsis

Frequency of respiratory symptoms in erosive gastro esophageal disease and the effect of high dose proton pump inhibitor

The aim of the study was to estimate the frequency and clinical spectrum of respiratory poblems in gastro esophageal disease and assess the response to high dose proton pump inhibitor [PPI]. This was a prospective study in which 382 patients were recruited in 2004 and 2005 who presented with heart burn or regurgitation and found to have esophagitis on endoscopy. Sixteen percent patients had respiratory symptoms with most common problem being chronic cough and asthma or asthma-like symptoms. Patients with hiatus hernia and higher body mass index had strong correlation with these symptoms. Fifty four percent of patients' symptoms improved on PPI. Maximum improvement was in the nocturnal symptoms Recognition and treatment of reflux can produce worthwhile improvement in respiratory illness. This response is sometime dramatic

Acute sarcoid arthropathy

A case of middle aged female with acute arthritis, mediastinal lymphadenopathy and diabetes mellitus is described. The patient underwent mediastinal lymph node biopsy and was diagnosed as having acute sarcoidosis [Lofgrens syndrome]. She was treated with systemic steroids and responded well