End treatment response with pegylated interferon among chronic Hepatitis C non-responders

To determine the frequency of end treatment virologic response [ETR] with pegylated interferon alpha and ribavirin in treatment of chronic hepatitis C patients who failed to respond to interferon plus ribavirin therapy given for at least 24 weeks. Descriptive study. Medical Unit-II, Benazir Bhutto Hospital, Shafi clinic Rawalpindi and PAEC Hospital Islamabad, Pakistan, from July 2208 to June 2009. Patients with hepatitis C who were non-responders to previous treatment with standard interferon and ribavirin, were given Pegylated Interferon alpha plus ribavirin. Total duration of treatment was 24 weeks for genotypes 2 and 3 and 48 weeks for genotypes 1 and 4. The primary end point was undetectable HCV RNA by polymerase chain reaction assay at the completion of therapy. Out of the 44 enrolled patients, 24 [54.5%] were males and 20 [45.5%] were females. Mean age of patients was 45.25 +/- 7.14 years. HCV genotypes were 3 in 64%, 2 in 30% and 7% each had genotypes 1 and 4. Both the early virological response and end of treatment response was seen in 75% patients. There was a high ETR rate of 75 in previous non-responders to conventional combination therapy. This high ETR as compared to international data is because of existence of favourable genotypes in our country which is encouraging in the treatment of non-responders

Presentation and complications of snakebite in a tertiary care hospital

To determine frequency of various modes of presentation, complications and management of snakebite. Descriptive case series. Medical Unit II, Rawalpindi General Hospital, Rawalpindi, Pakistan, from September 2006 to August 2007. All patients over 12 years of age and presenting to emergency department with history of snakebite and features of envenomation were included in the study. All these patients were given Anti-Snake Venom. Symptomatic treatment of complications was done. Semi-structured questionnaire was filled during hospital stay to analyze variouscharacteristics of snakebite and people's attitude towards this problem. A total of 65 patients were enrolled in the study with 40 males [61.5%] and 25 [38.5%] females. Maximum cases 15 [23%] were seen in the month of August. Age group, that was maximally affected, was between 26-30 years [12 cases or 18.5%]. Only 2 patients had neurotoxic snakebite, whereas rest of the cases were vasculo toxic in nature. Gum bleeding and cellulitis were the main presenting complaints. Mortality was 4.6% [3 cases]. A great majority of patients arrived late in the hospital because of lack of awareness and use of traditional though ineffective measures. Snakebite is a major public health problem. Patients with snakebite can be managed effectively provided timely administration of anti-snake Venom is done

Treatment induced leucopenia in hepatitis C and role of G-CSF in its management

To determine the frequency and severity of leucopenia during antiviral treatment in patients with hepatitis C and the effectiveness of G-CSF [Granulocyte-Colony Stimulating Factor] in its management. An observational study. Shafi Clinic, Rawalpindi, from July 2005 to July 2007. Patients with Polymerase Chain Reaction [PCR] positive for Hepatitis C Virus-Ribonucleic Acid [HCV-RNA] by Enzyme Linked Immunosorbent Assay [ELISA] method were included in the study. Standard combination therapy was given to all i.e. interferon and ribavirin. Those with total leukocyte count [TLC] <4000/cmm were given injection Granulocyte-Colony Stimulating Factor [G-CSF] according to severity of leucopenia. Response to therapy was noted and dose titration was done accordingly. A total of 208 patients were enrolled in the study with 99 [48%] males and 109 [52%] females. Total leukocyte count [TLC] < 4000/cmm was observed in 78 [37.5%] cases. Conventional interferon induced leucopenia was seen in 60 out of 172 [35%] cases. Pegylated interferon induced leucopenia was seen in 18 out of 36 [50%] cases. Patients on Pegylated interferon had more severe leucopenia as compared to those on conventional interferon. Granulocyte-Colony Stimulating Factor [G-CSF] administration resulted in an increase in mean total leukocyte count from 2300 to 5200/cmm. No patient required antiviral dose reduction or discontinuation. Recombinant Granulocyte-Colony Stimulating Factor [G-CSF] administration tends to manage leucopenia, which is a common adverse effect of antiviral treatment for hepatitis C