Prescribing patterns of antidepressants in Wad Medani area, Sudan

The important considerations in prescribing antidepressants are their safety and tolerability. Selective serotonin re-uptake inhibitors [SSRIs] are known to be as equally effective as tricyclic antidpressants [TCAs] with fewer side effects profile and better tolerance. The primary aim of this study was to determine the prescribing patterns of antidepressants in Wed Medani area. This cross-sectional, prospective hospital based study assesses the prescription pattern of antidepressant. It was conducted at Wed Medani Psychiatric Teaching Hospital and Hantoub Psychiatric Asylum and Clinic. 500 psychiatric prescriptions were selected at random using a data collection from and analyzed by SPSS. The most commonly prescribed CNS affecting drugs were antipsychotic agents, antidepressants, and antiepileptics. One hundred and fifty [30%] of the 500 prescriptions contained antidepressants. Selective serotonin reuptake inhibitors were prescribed in 25 [16.7%] prescriptions while TCAs were included in 125 [83.3%]. It was observed that only 33 [22%] of antidepressants prescriptions followed standard treatment guidelines. To improve the quality of care and to achieve benefits, treatment should be based on current best research evidence treatment guidelines for therapy of depression

Efficacy of percuatneous radiofrequency ablation in the management of hepatocellular carcinoma with schistosomisis

Radiofrequency ablation [RFA] is a well known therapeutic modality in the curative treatment of hepatocellular carcinoma [HCC]. The aim of this work was to assess the efficacy of percutaneous RFA in patients with tumors 400 ng/ml] and/or typical pattern of triphasic CT examination. RFA was employed to all patients. Triphasic CT examination was performed 1 month after the end of procedure and at three months interval for one year of follow up. Ultrasound examination and AFP were performed at 3 months interval for the same follow up period. Recurrence was considered when typical criteria were detected at triphasic CT examination. The results showed that full necrosis of the tumor was achieved in 42 patients in group I [93.3%] and in 41 patients in group II [93.18%]; [P>0.05]]. Recurrence after 1 year was detected in 11 patients of group I [26.19%] and 12 patients of group II [29.27%], [P> 0.05]

Pegylated interferon and lamuvidine in the treatment of Egyptian patients with HBe Ag positive chronic hepatitis B infection: S.ferritin as a marker of improvement

In Egypt, treatment of chronic HBV is not extensively studied and there were no comparative studies between different treatments all together. Also, worldwide, few such studies were performed with little or no significant differences in achieving both end of treatment and sustained virological responses when comparing lamuvidine to the combination of interferon and lamuvidine. The aim of this work is to compare the three arms of treatment; pegylated interferon, lamuvidine and combination of both agents; of chronic HBV infection who are HBe Ag positive in our Egyptian patients. This study included 71 Egyptian patients with chronic HBe Ag positive HBV infection divided into three arms: Group I including 23 patients treated with lamuvidine 100mg once daily for one and half year, group II including 23 patients treated with pegylated interferon alfa 2b 1.5micro g/kg/week for one and half year and group III including 25 patients treated with both agents for one and half years also. All patients were subjected to clinical, biochemical, histological and virological evaluation before, during and for about one and half years after treatment. History of schistosomiasis, antischistosomal treatment, in addition to ultrasonographic features of thickened portal tracts and antischistosomal antibody positivity were taken as evidences of presence of associated schistosomiasis. Serum ferritin level was estimated before and after treatment. Hepatitis serologies including HBsAg, HBsAb, HBeAg, HBeAb, anti HBdgG, and anti HCV and anti-HDV were determined by an enzyme immunoassay. Serum HBV DNA quantification was determined by a real time polymerase chain reaction [PCR], with serum samples obtained at baseline, at the end of therapy and one and half year later. The YMDD [tyrosine, methionine, aspartate, and aspartate] motif was tested on the serum samples at the end of first year of therapy or after by line probe assay. In lamivudine group, 30.4% showed complete biochemical and virological response to therapy with the mean ALT level of 35.29 +/- 5.06u/dL and AST level of 30.00 +/- 2.52u/dE in responding patients in comparison to 121.81 +/- 28.23u/dL and AST level of 107.25 +/- 39.48u/dL in non-responding patients after treatment. After 24 months, YMDD mutants were found in five patients in this group [21.7%]. In pegylated IFN group, 47.8% showed complete biochemical and virological response to therapy with the mean ALT level of 29.82 +/- 5.72u/dl and AST level of 22.6413.53u/dl in responding patients in comparison to 122.65 +/- 40.50u/dL and AST level of 112.33 +/- 23.02u/dl in non-responding patients after treatment. No YMDD mutants were detected during or after treatment. In combination therapy group, 32% showed complete biochemical and virological response to therapy with the mean ALT level of 30.00 +/- 3.12u/dl and AST level of 23.75 +/- 2.55u/dl in responding patients in comparison to 110.33 +/- 22.74u/dL and AST level of 144.71 +/- 44.18u/dL in non-responding patients after treatment. YMDD mutants were detected in 3 patients after the end of treatment [12%]. HBsAg and HBeAg seroconversion were detected more in patients treated by pegylated interferon and combination therapy but not statistically significant. Serum ferritin showed significant elevation [p<0.01] in all patients before treatment, and after treatment there were significant reduction in its levels in all groups [p<0.01] when compared to normal, this reduction was significantly obvious in responding than non responding patients in all groups. The change in histological activity index [HAI score] is significantly prognostic for interferon than lamuvidine therapy [p=0.014]. Changes in [HAI score] in combination therapy group was obvious than lamuvidine group but didn't reach statistical significance. In this study, no significant differences in biochemical and virological response between the three arms of treatment. Thus, from the virological point of view, three types of therapy are similar and still far from the hope of treatment of HBV. However, the development of YMDD resistance with the use of lamuvidine is a major concern and if a new nucleoside analogue can be added to or replace this drug to delay the development of resistance, such medications would be the best for their safety, route of administration and cost. The more HBsAg and HBeAg seroconversion in patients treated by combination therapy and pegylated interferon than lamuvidine, in addition to the rare development of YMDD mutants and the significantly better histological response; puts pegylated interferon in front of lamuvidine in the treatment of this disease. However, still the seroconversion and viral response is far beyond the goal and the door is widely open for more trials and different combinations to get the best effect adding new drugs recently approved for such infection such as adefovir, enticavir and others. Also, the dynamic observation of serum ferritin levels in patients with chronic viral hepatitis B during treatment might be helpful for monitoring and predicting patients' responses to the therapy

Denver peritoneovenous shunt in the management of refractory ascites due to chronic liver diseases: impact of patients selection on its outcome

Forty four patients with refractory ascites due to chronic liver diseases that fulfilling the inclusion criteria of selection were divided into 2 groups. The first group [G1, n=24] was subdivided into 2 subgroups according to degree of liver condition; GIa [n=11] with Child-Pugh class B and GIb [n=13] with early class C. The patients were subjected to P-V shunt [Denver group]. Similarly, patients in the second group [GII, n=20] were divided into 2 subgroups GIIa [n=10] and GIIb [n=10] respectively and treated by the repeated tapping and albumin infusion [control group]. Postoperative results revealed a significant increase in urine output [P

cross sectional study of hepatitis B, C, some trace elements, heavy metals, aflatoxin B1 and schistosomiasis in a rural population, Egypt

Chronic liver diseases are disastrous to health. Many factors are associated with their prevalence, hence endemicity. These are mainly infectious, parasitic and toxic. A survey was conducted in a village south to Cairo. Large industries concerned with iron and steel industry, metals smelting, cement manufacturing and electric station were located north to the village. A systematic random sample of houses was selected. All individuals inside the houses were invited to share in the study. Sample size was 84 individuals. Hepatitis markers were done [HBsAg and anti-HCV antibodies]. The levels of some heavy metals were assessed; which were lead, mercury, arsenic, aluminum, manganese, nickel, chromium and cadmium. Levels of some trace elements were assessed. These were copper, iron, selenium and zinc. Aflatoxin B1 was assessed in serum. Assessment of schistosomal circulating antigen and antibodies was carried out. Abdominal ultrasonograghy was done to assess liver condition. Univariate logistic regression analysis was done to assess the association between studied variables and HBsAg or anti-HCV sero-positive subjects. The association between studied variables and bilharzial or fatty liver, diagnosed by ultrasonography, were also assessed. The univariate logistic regression analysis revealed odds ratios at the following results. For HBsAg sero positive subjects, aflatoxin B1, lead, chromium and schistosomal antigen and antibodies were higher than negative ones where odds ratios were; 6.2, 1.6, 1.6, 1.6 and 1.7, respectively. None of the variables showed statistically significant difference. For anti-HCV antibodies sero-positive subjects, aflatoxin Bi and chromium had the highest odds ratios among the studied variables, [odds ratios were 2.5 and 2.4, respectively]. Bilharzial liver showed higher significant positivity of anti-HCV antibodies and insignificant decreased level of zinc than negative ones [odds ratios were 7.2 and 4.5, respectively]. Fatty liver cases showed higher statistically significant positivity of anti-HCV antibodies and chromium than negative ones. Odds ratios were 8.0 and 7.1, respectively. Statistically significant lower level of aflatoxin B1 was shown in fatty liver than normal liver subjects. Multivariate logistic regression analysis for fatty liver showed that only anti-HCV antibodies sero-positivity had statistically significant odds ratio in comparison to chromium level and aflatoxin B1. It is concluded that some heavy metals, and Aflatoxin B1 had a definite association with liver diseases in the area under study. Having anti-HCV antibodies had a relation with fatty liver and with bilharzial liver more than having HBsAg. It is recommended that environmental management to factories nearby the village is urgently needed to decrease exposure to heavy metals. Prevention of hepatitis infection and aflatoxin exposure through different means is also recommended, other wise health care authorities would be confronted with unusual cases of HCC in the nearby future