Hep-net opinion about the management of patients with chronic hepatitis C in Pakistan in the era of available direct acting antivirals

In Pakistan, we have 4.9% prevalence of HCV in general population, with 79% genotype 3. Recently Sofosbuvir has been made available at compassionate price in Pakistan. Management of chronic hepatitis C includes counseling of HCV patients, their proper assessment to select those who need antiviral therapy, initiation of appropriate antiviral agents and duration of therapy, along-with careful monitoring for safety and efficacy. Hepatic status as well as previous history of HCV therapy needs to be taken in the consideration before starting antiviral therapy. Other factors include co-morbid conditions like obesity, DM, NASH, etc. Treatment of special populations like liver transplant patients, patients with HBV co-infection, chronic kidney disease and hemoglobinopathies need special considerations when initiating HCV therapy

Pattern of upper gastro intestinal malignancies in northern Punjab

To record the number of cases of carcinoma of stomach, geographical location and histological diagnosis presenting to a hospital in northern Punjab. This study was conducted at the department of medicine [GI unit] Fauji Foundation Hospital Rawalpindi. All the patients who underwent upper GI endoscopy and were found to have an upper GI malignancy on histopathology were reviewed for part of the gut involved. Patient demographics including age, sex, and place of residence, clinical presentation, and subsequent histologic diagnosis were recorded. During the study period, 302 cases of upper GI malignancy were seen at our institution, 83 [14.8%] were in patients 40 years of age or younger. Mean patient age was 58 years. The lesion was distal in 43%, proximal in 20% and 7% involved the entire stomach. In 9.8% of the cases, lesser curve was the site. The tumor was located in the upper third, middle third and lower third in 33, 22 and 34.6% respectively. The common presenting symptom in case of carcinoma of stomach was pain epigastrium. Dysphagia was the major subjective complaint in cases of esophageal carcinoma. The common malignant tumor in males was carcinoma of stomach and in females carcinoma of esophagus. Endoscopic screening in subjects suspected of upper gastrointestinal malignancy results in a significant yield of carcinoma. The gastric tumor in distal location [non cardia cancer] is still more common. Asian race is no different from other races as far as the ca stomach is concerned

Intrabiliary rupture of hepatic hydatid cyst: role of ERCP

We report a case of hepatic hydatid cyst presenting with obstructive jaundice following cholecystectomy. ERCP showed intrabiliary cyst rupture with biliary obstruction due to cyst remnants. Endoscopic sphincterotomy was performed and cyst debris removed with complete resolution of symptoms

Immunogenicity and economic evaluation of different recombinant hepatitis-B vaccines in different dosages, schedules, and routes of administration

To measure the immunogenic response produced by recombinant DNA derived vaccines in different dosages, schedules, and routes of administration. Another objective was to evaluate the minimum dosage and compliant schedule of recombinant DNA derived vaccine required to produce effective immune response and its economic evaluation in the adult population. Five hundred fifty eight healthcare workers in the age group of 20-50 years from Military Hospital Rawalpindi, Pakistan and other sister institutions were enrolled. Two hundred fifty eight were excluded due to serological evidence of HBV infection. Remaining three hundred were divided into five groups each having sixty volunteers with equal male to female ratio and age groups 20-29,30-39, 40-50. First four groups were injected with Heberbiovac vaccine and last group-V was given inj. Engerix-B. In Heberbiovac arm: Group-I received standard dose of 20Microg at standard schedule of zero, one and six months intramuscularly. In Group-II, dose was reduced to half [10Microg] intramuscularly. Group-III was given only two standard doses of 20Microg at zero and one month interval intramuscularly and Group-IV received intradermal dose of 3Microg at zero, one and six months. Group-V was given Engerix -B in standard dosage and schedule, [i.e., 20Microg at zero, one and 6 months]. Immunogenic response was measured in all the groups eight weeks after the last dose. Response was measured with MEIA/IMX system by ABBOTT. Both the vaccines were equally immunogenic but higher titers of Anti HBs was achieved with Heberbiovac. In Heberbiovac arm of study, seroprotection rate was 96.36% in Group-I, in Group-II it was 94.64%, in Group-III 95% and in intradermal group 98.14%. In Engerix -B group it was 92%. Two doses/Half dose schedule/intradermal route of 3Microg of Inj. Heberbiovac is equipotent to that of standard dose/schedule of Inj. Heberbiovac or Inj. Engerix-B in terms of seroprotection rate achieved

Outbreak of dengue haemorrhagic fever in Karachi

In 1994, there occurred two separate outbreaks of febrile illness in Karachi. These were characterized mainly by thrombocytopenia. Haemorrhages were observed in number of cases. This prospective study included 120 cases who dropped their platelet count below 100,000/cmm. All were adult males with the mean age of 27.1 years. Duration of fever was 3.14 days [mean 7.5]. Vomiting and nausea were seen in 77.5% and 59.1% cases. Myalgias, headache and backache were other common symptoms. Haemorrhages were found in 53.3% cases with epistaxis in 17% and bleeding gums in 14.1%. Platelets were between 90,000 to 100,000 in 23.3%, in 42.6% cases count was between - 50,000 - 90,000 and below 50,000 in 34.1% with the mean count of 58000/cmm. In 1994, six out of seven sample processed were positive for antibodies against dengue type II. In 1995, 15 out of 34 samples tested were positive for the same dengue type. One patient died of myocariditis. Rest of patients recovered. Occurrence of dengue fever in Karachi has been documented and this should now be considered in the differential diagnosis of undiagnosed cases of fever. Myocarditis as cause of death in dengue fever has also been documented inviting further research and discussion

Spirometric values in normal Pakistani population

This study was carried out at Karachi to find out the spirometric values in healthy non-smoking Pakistani population of both the sexes of ages from 10 to 69 years. The results were compared with predicted normal values which vary with age, sex, height, ethnic origin and regional conditions. In our population, spirometric values were found to be lower than their matched western counterparts. FVC, FEV, were observed to decrease with age and become comparable with western population around the age of 50 years in case of males but in females difference persists. PEFR also decreased with age in males but in females there was hardly any decline after the age of 45 years