Management of Hepatitis C Virus Infection - New Era Has Been Started.

Hepatitis C virus is a major cause of chronic hepatitis and is responsible for majority of liver transplantation worldwide. It has got no vaccine for prevention. Interferon containing regimen was the only management options for treatment of Hepatitis C virus till last year. Due to side effect profile and treatment cost this treatment options was not reachable for general population. Besides, response rate was not so satisfactory (Genotype 1, 40-50%, Genotype 2 & 3, 70-80%). New oral antivirals were introduced in 2014 which has got little side effect profile as well as good treatment response rate (80-95%). These new drugs with their different combination regimens along with indications, contraindications and treatment monitoring of Hepatitis C virus are discussed briefly in this review.

Antimicrobial Sensitivity Pattern of Helicobacter pylori Isolates among Subgroup of Bangladeshi Patients.

This cross sectional study was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU) and International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009. Aim of the study was to find out the antimicrobial susceptibility profile of Helicobacter pylori isolates from dyspeptic patients. Total 224 dyspeptic patients from Out Patient Department (OPD) of BSMMU were initially enrolled after informed written consent. After upper GI endoscopy 157 patients were finally included who had erosions, ulcers or atrophic changes in the stomach or duodenum. Two biopsy samples were taken from each of them. Samples were incubated at 370C in a double gas incubator with 5%O2, 10%CO2 and 85%N2. Total 82 (52.23%) samples were found positive for H. pylori. Isolated organisms were then tested for sensitivity to Amoxicillin, Clarithromycin, Tetracycline, Levofloxacin and Metronidazole by Agar dilution method. Among 82 patients 51(62.2%) were male and 31(37.8) were female with a male:female ratio 1.6:1. Patients were categorized into two groups one having gastric or duodenal ulcer (30.5%) and other having no ulcer (69.5%). Among these isolates 92.7% were sensitive to Amoxicillin, 89% to Clarithromycin, 81.7% to Tetracycline, 80.5% to Levofloxacin and only 26.8% to Metronidazole. Beside these, 81.7% isolates were sensitive to both Amoxicillin and Clarithromycin, 74.4% to Amoxicillin and Tetracycline, 73.2% to Amoxicillin and Levofloxacin, 72% to Clarithromycin and Tetracycline, 59% to Clarithromycin and Levofloxacin and 51% to Tetracycline and Levofloxacin.

Efficacy of Different Laboratory Tests to Diagnose Helicobacter pylori Infection.

Helicobacter pylori is a Gram negative bacteria which causes chronic gastritis, peptic ulcer disease, primary B-cell gastric lymphoma, and adenocarcinoma of the stomach. There are a set of laboratory tests to diagnose H. pylori infection with a variable accuracy, they are divided into non-invasive tests and invasive tests. Non-invasive tests include serology, urea breath test (UBT) and stool antigen test (SAT). Invasive tests include rapid urease test (RUT), histology and culture. This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and H. pylori laboratory of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from July 2008 to September 2009 to evaluate the efficacy of RUT, SAT and Culture as a diagnostic tool for H. pylori. Dyspeptic patients were collected from outpatient department of BSMMU. Out of 224 dyspeptic patients 149 patients had ulcers or erosions in the stomach or duodenum. Stool sample could be collected from 139 patients. RUT has sensitivity of 100%, specificity 80.28%, positive predictive value 85% and negative predictive value 100%. Regarding culture, sensitivity is 100%, specificity 94.37%, positive predictive value 95% and negative predictive value 100%. Stool antigen test has sensitivity 95.94%, specificity 92.31%,positive predictive value 93% and negative predictive value 95%.

EPI Coverage among Under 5 Children Attending Pediatric Department of Dhaka Medical College Hospital.

This cross-sectional study was carried out among 1000 children between 10 months to 5 years of age during November 2004 to February 2005 attended in the department of pediatrics, Dhaka Medical College Hospital (DMCH) with different childhood illness. Aim of study was to know the Immunization (EPI) coverage, dropout rate and factors influencing dropout. According to parent's statement, 82.5% of the children were fully, 16.1% were partially and 1.4% were non-immunized. Specific immunization coverage revealed that, 97.3% were immunized with BCG, 96.7% with DPT1/OPV1, 92.9% with DPT2/OPV2, 91% with DPT3/OPV3 & 84% with measles vaccine. Among the BCG vaccinated children 91.77% had BCG scar. Drop out of DPT1-DPT3 was 5.78% & DPT1- measles was 12.88%. The main reason found for non-immunization were lack of faith in programme (57.1%), lack of awareness (21.4%), and fear of side effects (21.4%), whereas lack of awareness (41.6%) and illness of child (32.9%) played role behind drop out. Drop out cases were found to be associated with female sex, parent's illiteracy, higher number of children in the family and father's occupation (p<0.001), whereas mothers occupation had no independent effect on coverage (p>0.05). The study findings suggested that despite the effort taken by Government and NGOs to expand coverage, dropout rates are unacceptably high. To combat this challenge counseling and motivation on EPI, improvement of information system, health education and training of health workers are required.

Evaluation of Prescribing Pattern of the Private Practitioners in Bangladesh.

A prescription order is a written instruction of doctors to pharmacist to supply drugs in particular form to a patient and the directions to the patients regarding the use of medicines. This study was undertaken to observe the prescribing patterns of the private practitioners in Bangladesh, 430 prescriptions were collected randomly from Dhaka city and analyzed using WHO/INRUD indicators. There were average 3.40 drugs per prescription. Drugs were prescribed in generic name only in 0.20%. About 46.31% drugs were prescribed from the Essential Drug List, only 19% of prescriptions were complete in respect to patient medication information. Antibiotics were prescribed in 70.33% of the prescriptions; injections were prescribed in about 8.35% of the prescriptions.

Risk Factor for Relapse in Childhood Nephrotic Syndrome - A Hospital Based Retrospective Study.

Nephrotic Syndrome (NS) is a common childhood illness characterized by massive proteinuria, hyperlipidemia, hypoalbuminemia & edema. NS is a disease of relapse and it is a major problem to manage the cases with frequent relapse. So it is very important to find out such children who are prone to develop frequent relapse. This retrospective study was conducted in the paediatric department of Dhaka Medical College Hospital (DMCH) from January to December 2005.Total 100 children with relapsed NS of them 50 had Frequent Relapse NS (FRNS) and 50 had Infrequent Relapse NS (IFRNS) were included in the study with a view to find out the risk factors for relapse. Data were collected from previous medical and hospital records. Data were analyzed by using SPSS program. Chi-squared test and Student's t-Test were used as statistical test and p value < 0.05 was taken as significant. NS was more common among 2-6 years of age (67%) with male to female ratio roughly 2:1. Most of patient with frequent relapse had age <5 years, came from rural area and belongs to poor social class compared to that of infrequent relapse. The mean age at first onset was significantly less in frequent relapse group than that of infrequent relapse group. Majority of atopic child belongs to frequent relapse cases. Low serum albumin level, low serum total protein level, culture positive Urinary Tract Infection (UTI) at initial attack were observed to be statistically significant in case of frequent relapse group.

Familial Hypoparathyroidism with Pregnancy- Challenging Issue for Patient as well as for Physician.

Familial hypoparathyroidism is a rare cause of hypoparathyroidism. It may be x-linked recessive, autosomal dominant or autosomal recessive. In autosomal dominant hypoparathyroidism there is activating mutation of the calcium sensing receptor leading to inhibition of Parathormone (PTH) secretion at inappropriately low serum ionized calcium level. The disease often manifests in the first decade but may appear later. Clinical signs primarily involving neuromuscular disturbances including generalized seizure. Management of pregnancy in hypoparathyroidism is challenging as both under treatment and over treatment is dangerous for fetus. Treatment of hypoparathyroidism in pregnancy includes combination of oral calcium supplementation with calcitriol with an aim to keep serum calcium within normal range. Here we discussed a case of 21 year pregnant lady with familial hypoparathyroidism with successful delivery of a healthy baby.

Effects of Griseofulvin in the Treatment of Lichen Planus -A Study in BSMMU.

Lichen Planus (LP) is an inflammatory disorder of skin, mucous membranes, nails and hair. There are various modalities of treatment but none is curative. This prospective therapeutic trial was done among patients with lichen planus at the outpatient department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka between November 2001 and April 2002. Total 20 patients were taken of them 12 were male and 8 were female with male to female ratio 3:2. Age of the patients was between 10 to 50 years. Patients were diagnosed clinically & confirmed histologically. They were treated with griseofulvin 500 mg daily for 6 months. Out of 20 patients, 8 had only oral lesions, of them 2 (25%) showed complete response, 3(37.5%) showed moderate improvement and 4 (37.5%) showed no response. Other 12 patients had lichen planus involving skin without oral mucosa, of them 4 (33.3%) showed moderate improvement, 4 (33.3%) showed no response and 4 (33.3%) patients worsens with treatment. So, success in patients with cutaneous lichen planus is less likely; however, griseofulvin may afford relief in selected patients with oral lesion. This study indicates that further prospective placebo controlled studies are needed to clarify the efficacy of griseofulvin in lichen planus.

Clinical Presentation, Histological Findings and Prevalence of Helicobacter pylori in Patients of Gastric Carcinoma.

Carcinoma stomach is the second leading cause of cancer death worldwide. This study was undertaken to determine the clinical and pathological profile of carcinoma stomach in Bangladesh and to find out the prevalence of H. pylori infection in carcinoma stomach subjects. Patients with carcinoma stomach confirmed on histopathology were included in the study. Data were recorded regarding demography, clinical features, blood group of the patients, location and macroscopic type of the cancer at endoscopy. Three to five biopsies from non-necrosed region and two paired biopsies from non-cancerous part of stomach were taken. One piece of each paired specimen was placed in the urea-agar media for CLO test and the other piece was used for histological examination. Out of 50 patients, 64% were male and 36% were female. The mean age was 51.05±14.98 years. Common presenting complains were dyspepsia/ abdominal pain, vomiting and dysphagia; abdominal mass, metastatic lymph node and ascites were predominant signs. About one third (34%) patients had blood group A. About 50% cancer was located in antrum followed by antrum and body (24%), then body (18%), fundus and body (4%) and fundus (4%). In 56% cases the lesion was ulcerative followed by polypoid (34%) and ulceroinfiltrative (10%). Histopathologically 52% was intestinal type, 28 % was diffuse type 20% was poorly differentiated adenocarcinoma. The prevalence of H. pylori in overall carcinoma stomach cases was 60% but individually in intestinal type 88%, in diffuse type 57% and in poorly differentiated type 50%.