Frequency of HBeAg positivity in chronic hepatitis B infected patients

Objective: To determine the frequency of HBeAg positivity in chronic hepatitis B infected patients

Methodology: This descriptive cross-sectional study was carried out for one year between June 01, 2014 till May 30, 2015 in a private consulting clinic at Ibrahimi Hospital, Dabgari Gardens, Peshawar - Pakistan. A total of 149 patients were included in the study. All patients of either gender between 15 to 70 years of age, newly diagnosed with HBV infection in the form of positive HBsAg on third generation ELISA were included in the study. In all the patients, HBeAg was checked. Data were analyzed using SPSS version 20.0

Results: Out of the total 149 patients between 20 to 60 years [mean 41 +/-8.7] included in the study, the males 112 [75.2%] outnumbered the females 37 [24.8%]. The prevalence of HbeAg in chronic HBV was 28.2 % [males 16.10 %, females 12.08%] with more patients [22.14%] between 21 and 40 years of age

Conclusion: The frequency of HbeAg was found in a significant number of chronic HBV patients. Its frequency was more in males and in the age group of 21 to 40 years

Telbuvidine monotherapy in the treatment of HBeAg positive chronic hepatitis B infection with normal baseline ALT levels

To study the effect of Telbuvidine [LDT] mono therapy in the treatment of HBeAg positive Chronic Hepatitis B infection [CHB] with normal ALT levels. Ninety HBe antigen [HBeAg] positive CHB infection patients were enrolled and followed between June 2008 and June 2011. All of them had ALT levels less than twice the upper normal limit [Mean 36.9 SD 19.9]. All patients were HBeAg positive, had serum DNA level >10[4] copies/ml and never had previously received anti HBV treatment. All patients were given LDT 600mg daily as initial antiviral treatment for two years. Out of 83 patients who continued the treatment as per protocol, 59 were males and 24 were females between ages of 21 and 50 years. Baseline HBV DNA levels were 7.82x10[7] copies/ml [Range 4.8x10[4]-8.3x10[9] copies/ml]. By the end of first year [52 weeks] the mean decrease in serum HBV DNA levels was 7.88 log[10] copies/ml and the proportion of patients having undetectable HBV DNA levels was 73%. At the end of second year of therapy [96 weeks] the percentage of undetectable HBV DNA levels increased to 86%. At the end of 1[st] [52 weeks] and 2[nd] [96 weeks] HBeAg seroconversion rates were 62% and 86% while HBsAg seroconversion was 8% and 13% respectively. LDT is a reasonable cost effective therapy for HBeAg reactive CHB patients with normal baseline ALT levels resulting in a significant serological and virological response and was well tolerated in our population of Khyber Pukhtunkhwa

Efficacy of telbivudine in the treatment of chronic hepatitis B infection in population of Peshawar, Pakistan

To study the efficacy of telbivudine in 2 years treatment of chronic hepatitis B infection in local population of Peshawar. This study was conducted in Khyber Teaching Hospital, Peshawar from June 2007 to June 2012. 83 patients, 56 males and 27 females of chronic hepatitis B with no other liver problem like hepatitis C and D, alcoholic hepatitis, fatty liver, hepatocellular carcinoma etc were included in the study. HIV, pancreatitis and pregnancy was also ruled out before study was undertaken. Base line investigations of CBC, Liver and kidney profile, CPK, HBsAg, HBeAg, HBe antibody, HBV DNA, Ultra sound abdomen and upper GI endoscopy were conducted in the subjects. Each patient was given oral telbivudine 600mg/d for 2 years. Biochemical, serological, virological and clinical follow ups were conducted after one month of starting treatment and then every 3 months. Biochemical, serological and virological end points were observed beside adverse effects of telbivudine. Data was analyzed using SPSS version 15.0. Mean serum ALT was reduced from 36.9 iu/ml from first visit to 21.0 iu/ml [p value=0.001] after 24 months of treatment. The serum viral load decreased from 165277.82 iu/ml to 3.80 iu/ml from initial to final visit after 2 years of treatment. No viral breakthrough was reported during 24 months of treatment with telbivudine. The drug was well tolerated without any significant adverse effects. Treatment of chronic hepatitis B patients with telbivudine shows statistically significant reduction in viral load and serum ALT with no significant adverse effects

Frequency of helicobacter pylori in patients with upper G.I symptoms

Our study aimed to determine the frequency of H pylori infection in our local population. 100 sequential patients undergoing upper gastrointestinal endoscopy were tested for the presence of H pylori infection by the urease test. All patients were tested for the presence of H pylori regardless of endoscopic findings. Of 100 patients, 39 were male and 61 were female. Patients age ranged from 13 years to 85 years, mean age being 39.9 years. Positive endoscopic findings were detected in 32% cases. 65% cases [42 female, 23 male] tested positive for H pylori infection. Of those who tested positive, 20 patients [30.7%] had significant upper Gl pathology detected. Of patients who were negative for H pylori infection, 12 [34.28%] had significant upper Gl pathology detected. Of a total of 61 female patients undergoing endoscopy, 68.8% tested positive for infection with H pylori, whereas 58.9% of the male patients test positive. Of 100 patients, 47 were aged 40 or above of which 55.3% were H pylori positive; 53 patients were below 40 years of age and of them, 75.3% were H pylori positive. We conclude that significant proportion of Pakistani population harbours H. Pylori and due consideration should be given to H. Pylori status of a person presenting with diseases with strong link with this organism

Plasmodium falciparum malaria with bleeding diathesis-an experience in NWFP

Falciparum Malaria is a syndrome and a disease of protean clinical manifestations including DIG. This descriptive study was conducted in Medical department of Khyber teaching hospital Peshawar from January 2004 to August 2005. Fifty patients between the ages of 15 to 70 years, who presented with fever and bleeding manifestations, having positive trophozoites of plasmodium falciparum in blood smear, were included. Out of 50 patients 27 [54%] were males, while 23 [46%] were females. Male to female ratio was 1.17:1. The age of the study group ranged form 15 to 70 years. Maximum number of patients were in the age group 15-29 years [44%]. Fever was noticed in 48 [96%], anemia in 32 [64%] and splenomegaly in 33 [66%]. Bleeding diathesis was noticed in 3 [6%] patients with prolonged PT, APTT, thrombocytopenia and raised FDPs, Four patients had thrombocytopenia and positive FDPs in low titre, with 03 patients having prolonged PT and APTT but no clinical evidence of bleeding. We conclude that any patient with history of fever and bleeding diathesis, falciparum malaria should be considered in the differential diagnosis

One week eradication therapy for helicobacter pylori

1. To determine the efficacy of one week treatment in the cure of Helicobacter Pylori [H pylori] infection using triple regimen including Clarithromycin, Amoxicillin, and a Proton Pump Inhibitor [PPI]. 2. To identify the differences, if any, in response to treatment between patients from Pakistan and the rest of the world. Patients with endoscopically proven peptic ulcer disease and H pylori infection confirmed by urease test were given PPI based triple therapy for one week and then PPI was continued for another week. After two weeks, endoscopy and urease test was repeated to assess H pylori eradication. There were 32 patients [20 male, 12 female, mean age 38.9 years] included in the study. All had endoscopically proven peptic ulcer at initial diagnosis and all were positive for H pylori infection. On repeat endoscopy two weeks later, 27 patients [84.3%] showed complete ulcer healing and PPI was stopped, whereas 5 patients showed signs of partial healing. In the latter, PPI was continued for another week, and on repeat endoscopy at end of therapy, all ulcers showed complete healing. Urease test was repeated in all patients at second endoscopy and was negative in 28 patients [87.5%]. We conclude that one week of triple therapy followed by PPI for one week is sufficient for eradication of H Pylorl

One week eradication therapy for Helicobacter pylori

Studies have been published from most parts of the world regarding optimal duration of treatment for peptic ulcer disease and for eradication of Helicobacter Pylori with some statistical differences therein. Worldwide consensus on this issue has still not been reached. The primary objective of the present study was to elucidate the role of the duration of treatment in the cure of H. Pylori infection. We aimed to determine whether one-week triple therapy is effective for eradication of H Pylori, so that a cost-effective protocol could be developed. Also to see if there was any difference in response in patients from this part of the world, as no such study has been previously reported from Pakistan. Patients with endoscopically proven peptic ulcer disease and H Pylori status confirmed by urease test were given PPI based triple therapy for one week and then PPI was continued for another week. After two weeks, endoscopy and urease test was repeated to assess H Pylori eradication. There were 32 patients [20 male, 12 female, mean age 38.9 years] included in the study. All had endoscopically proven peptic ulcer at initial diagnosis and all were positive for H Pylori infection. On repeat endoscopy two weeks later 27 patients [84.3%] showed complete ulcer healing 'and PPI was stopped, whereas 5 patients showed signs of partial healing. In the lattei PPI was continued for another week, and on repeat endoscopy at end of therapy, all ulcers showed complete healing. Urease test was repeated in all patients at second endoscopy and was negative in 28 patients [87.5%]. Our results were in keeping with other similar studies from different parts of the world. We conclude that one week of triple therapy is sufficient for eradication of H Pylori

Incidence of spontaneous bacterial peritonitis in liver cirrhosis, the causative organisms and antibiotic sensitivity

To find out the incidence of spontaneous bacterial peritonitis in patients with liver cirrhosis having ascites, the causative organisms and their antibiotic sensitivity. This study was conducted in Medical Ward of Khyber Teaching Hospital, Peshawar from 1st June 2001 to 31 of March 2003. Patients having liver cirrhosis confirmed previously by histopathology and now presenting with fever with or without chills, abdominal discomfort, increasing abdominal distension, confusion and hepatic encephalopathy, were included. A total of 200 patients were studied. Out of 200 patients included, spontaneous bacterial peritonitis [SBP] was present in 102 patients. Classical SBP was present in 38.23%; Culture Negative Neutrocytic Ascites [CNNA] was present in 57.84% while Bacterascites was present in 03.92% of patients. E Coli was isolated in 58.13%, Streptococcus pneumoniae in 18.60%, Staphylococcus auras in 09.13%, Klebsiella in 09.13% and Acinetobacter in 04.65%. Out of 102 cases of SBP, blood cultures were positive in 21.56%, urine cultures in 15.68% and throat swabs in 10.78% of patients. E Coli was again the commonest organism isolated from blood cultures. All the organisms were sensitive to 3rd generation cephalosporins, and quinolones. Spontaneous bacterial peritonitis is quite a common complication of liver cirrhosis with ascites. Patients usually present with abdominal pain, abdominal tenderness, fever with or without rigors, jaundice, and hepatic encephalopathy. E Coli is the commonest organism followed by streptococcal pnaemoniae. Quinolones and 3rd generation cephalosporins are 100% effective in the management of spontaneous bacterial peritonitis