Pegylated interferon and ribavirin for post liver transplant HCV recurrence

Pakistan has a very high HCV prevalence[1] with majority being genotype 3. A high number of patients with cirrhosis undergo liver transplantation. HCV recurrence following transplant is universal[2]. Interferon free therapy has recently become available and preliminary studies show 70% SVR in post transplant patients[3]. Since genotype 3 has a high response to pegylated Interferon 3, it remains a competitive agent

Aims and Methods: The aim of this study was to determine the efficacy of pegylated interferon plus ribavirin in the treatment of recurrent hepatitis C following liver transplantation. 15 patients with recurrent hepatitis C following liver transplantation were included in the study, 13 males and 2 females. Mean age was 52 years. 13 had genotype 3 disease, one genotype 2 and one genotype 1.11 were living donor and 4 were cadaveric grafts. 13 were on tacrolimus and MMF, one on tacrolimus alone and one on cyclosporine and MMF. 6 patients were treated within 2 years of transplant and remaining 9 were treated 3-5 years after transplant. Liver biopsy was done prior to therapy in 6 patients. All patients received pegylated interferon a2a 180 g weekly plus ribavirin 15mg/kg daily for 48 weeks

Results: 14 out of 15 patients [93.3%] achieved SVR. This included all 13 Genotype 3 patients [100%] and the single genotype 2 patient. One patient, genotype 1, was nonresponder to treatment. Treatment was stopped at 22 and 36 weeks in 2 patients due to anaemia. Both achieved SVR. 11 patients were administered erythropoietin for anemia. 7 patients required ribavirin dose reduction for anemia, and achieved SVR despite dose reduction

Conclusion: Pegylated interferon and ribavirin is an extremely effective combination for treatment of patients with recurrent genotype 3 hepatitis C after liver transplantation. The main side effect is anaemia, which can be managed with erythropoietin supplementation and ribavirin dose reduction without any reduction in response rate

First dose response of treatment of three formulations of interferon alpha in patients using limited sampling strategy

The study was conducted to observe the comparative response of three commercially formulations of interferon alpha 2b in three groups of patients with chronic hepatitis C. The objective was to see best response after first dose of interferon Alfa 2b. This was a quasi - experimental study in which patients of both sexes between ages 20 -49 were randomly allocated to receive three different formulations of interferon alpha 2b in three groups, I, II, and III, after giving them first dose of three million units of interferon alpha 2b subcutaneously. Sixty patients were selected in three groups according to the formulation injected. Blood samples were collected at 00, 08, 20 hours according to limiting sampling strategy. All samples were analyzed by ELISA. The response of serum drug level was different between three groups. Statistically significance differences were observed between group I and II, and group I and III, based on ANOVAs and t-test. Comparison between three groups was significant. Almost all subjects [98%] reported typical mild interferon side effects [flu - like symptoms, headache]. Different formulations have variable response of serum drug level

Efficacy of argon plasma coagulation in gastric vascular ectasia in patients with liver cirrhosis

To determine the efficacy of Argon Plasma Coagulation [APC] in terms of improvement in hemoglobin level and disappearance of telangiectasia as endoscopic treatment for Gastric Antral Vascular Ectasia [GAVE] and Diffuse Antral Vascular Ectasia [DAVE] syndrome in liver cirrhosis. Quasi experimental study. Department of Gastroenterology and Hepatology of Shaikh Zayed Hospital/ Federal Postgraduate Medical Institute, Lahore, from January, 2006 to July, 2007. Cirrhotic patient with gastric vascular ectasia were enrolled and followed-up for 18 months with repeated sessions of APC. Efficacy of APC was evaluated on the basis of patient's symptoms, transfusion requirements and hemoglobin levels. APC was performed by using ERBE generator set at 60 W and flow rate 2.0 L/min using primarily endfiring probes. Fifty patients were enrolled in the study. Mean age was 55.78+1.24 years with 32 males and 18 females giving a male to female ratio 1.7:1. Forty two patients were in Child's Class C and 8 in Child's Class B. Presenting complaints were malena and anemia. Two hundred and fifty three APC sessions were carried out; mean 5.06 + 1.5 sessions per patient. Mean follow-up period after the last session was 8.5 + 3.7 months. Mean increase in the hemoglobin level was 1.35 + 0.24 g/dl. There was no death of any patient during the study period. Treatment with APC is an effective and safe method to decrease blood loss in patients with GAVE and DAVE

Teaching biostatistics and epidemiology in a postgraduate medical institution: are we going in the right direction?

We examined the attitude and knowledge of 40 supervisors and trainees as well as the impact of workshops on statistical thinking and analytical processes in a medical facility in Pakistan: 45% thought that statistics and epidemiology should be left to professional statisticians; 86% of the trainees and 58% of the supervisors, however, thought that statistics should be taught as a full-time subject. The majority of trainees [86%] were dissatisfied with the workshops compared to 33% of supervisors. Our findings indicate an urgent need to revise our approach to teaching statistics and epidemiology

Successful treatment of watermelon stomach / GAVE syndrome by using argon plasma coagulation

This case report describes a 50-year-old female patient with liver cirrhosis presented with anemia. She was found to be suffering from gastric antral vascular ectasia [watermelon stomach] on upper gastrointestinal endoscopy. She underwent multiple sessions with Argon plasma coagulation, a non-contact thermal method of hemostasis for the management of watermelon stomach. After 3 sessions, the lesions disappeared and the hemoglobin increased by 2.4 gm/dl without any need of transfusion

Living donor renal transplantation our experience in SIMS/Services Hospital, Lahore

Kidney transplantation is the treatment of choice for end stage renal disease [ESRD] patients. However organ shortage remains the central problem in kidney transplantation. To deal with the widening gap between supply and demand of organ for renal transplantation, efforts to expand the organ donor pool have received increased attention. To solve this problem, we have initiated a living related and unrelated living donor programe using emotionally related persons, friends and well motivated volunteers as organ donors. A total of 18 patients with live donor underwent kidney transplantation in Sims /Services Hospital over a period from March 2006 to December 2006. The aim of study is to highlight the problems and identification of factors limiting the number of transplantation and further prospects of renal transplantation in Pakistan. The cause of ESRD was HTN 7 [38.89%], Chronic Glornerulonephritis 4 [22.22%], Calculus Renal failure 4 [22.22%], and Diabetic Nephropathy 3[16.67%].The donor age ranged between 20-55 years [mean 28.39].The recipient age ranged 17-56 years [mean32.73]. Relationship of donor to recipient was sister 1 [5.56%], 1st degree relatives 3 [16.7%], friends 4[22.22%], unrelated 10[55.56%]. In our study graft survival was 88.89%, patient survival 94.45%, mortality 5.56%. Transplanted patient has to be better motivated to take medication regularly and get the investigations. It was observed that 1st degree relation are very limited source of donors in this part of the world and unrelated donors certainly encourage, transplantation

Meatal stenosis in circumcised males - Is it preventable?

Meatal stenosis is most commonly seen among the circumcised males. The true incidence of this post circumcision complication is not known. The most favored hypothesis regarding the etiology is ammoniacal fumes produced in the wet diapers, which cause meatitis of unprotected glans. It is treated by meatoplasty. 26 pediatric patients suffering from meatal stenosis were treated between Jan. 2003 and Dec. 2005 both inclusive [Mean age was 4.36 years and ranging 2 - 10] and mean follow up was 4 months. Patients were studied for presenting symptoms, size of meatus, perimeatal balanitis, pyuria and postoperative complications such as bleeding, infection and recurrence. They were advised postoperative dilatation with ophthalmic ointment nozzle for one month. Patients with prior history of circumcision were included in the study. The most common symptom in our study was thinning of urinary stream 17 [65.4%] cases. Other common symptoms were painful micturition in eight and bloody spotting in seven cases. Eight patients were having pin hole meatus and three cases were having pyuria. Compliance for post operative dilatation was 76.9% [20 cases]. No case of recurrence was seen. It can be concluded that meatal stenosis is related to infant circumcision. It is treated by meatoplasty with satisfactory outcome. Whether we would be able to prevent this post circumcision complication ? There is no obvious solution to this problem for the time being

Blood Culture and sensitivity pattern in neonotology unit of children hospital Lahore

To identify spectrum of organisms causing neonatal sepsis and the sensitivity pattern against commonly used antibiotics. Prospective descriptive study. Blood samples were taken from all neonates with clinical suspicion of sepsis before start of antibiotics and sent for culture by standard method. The data obtained from January 2004 to June 2004 was analyzed and results were tabulated. A total of 1900 blood samples were taken. Cultures were positive in 524 samples [27.6%]. E Coli was the most common organism found [31.67%] followed by Staph Epidermidis [24.80%], Klebsiella [19.08%] and Pseudomonas [14.69%]. Amikacin was the most effective drug followed by Co-Amoxi Clav, Ciprofloxacin, Imipenem and Ceftazidime in that order. Gram positive and gram negative organisms showed a high degree of resistance against Ampicillin and Gentamycin respectively. Neonatal sepsis is one of the leading causes of morbidity and mortality. Gram negative organ isms are the major cause of neonatal sepsis in NNU of Children Hospital. In this study these organisms showed resistance against commonly used antibiotics [Ampicillin, Gentamycin and Cefotaxime].There is a need to modify already existing protocol in NNU of Children Hospital

Role of cyclosporin treatment of nephrotic syndrome in children

Cyclosporin [Cs-A] was tried in 20 patients aged 1-15 years. Ten of these were steroid resistant and 10 were steroid dependent. At the end of 12 weeks, complete remission was seen in 8 steroid dependent and 2 steroid resistant children. These patients were followed up for a minimum period of one year. On the whole long term remission was seen in 4 out of 20 patients [2 steroid resistant and 2 steroid dependent]. There was no significant difference in the mean duration of remission between steroid dependent and resistant groups after stopping Cs-A [0.5>p>0.1]. Minimal change histology and steroid responsiveness was associated with better outcome with Cs-A therapy [p<0.01]. No major side effects of CsA were observed

Clansman's thrombasthenia

The spectrum of clinically apparent bleeding in patients with hemorrhagic tendencies varies from minor pin point cutaneous hemorrhages to a massive fatal internal bleed. Hereditary bleeding problems usually manifest early in life with a history of hemarthroses, bleeding after surgery, circumcision or dental extraction. Investigation of these bleeding disorders concentrates usually on evaluation of hemophilias and Von Willebrand's disease. Case history of a young man with bleeding tendency secondary to Glanzmann's Thrombasthenia, a very rare qualitative platelet disorder is presented, Clinical features, pathogenesis and diagnostic strategy are discussed