Thyroid dysfunction; during combined peg-interferon Alpha-2a and Ribavirin therapy in patients with chronic hepatitis C

Hepatitis C is a burning issue. Prevalence of hepatitis C virus reported in Pakistan is 5% with areas of high infection in different cities and subsets of population. To find out the frequency of thyroid related dysfunctions in chronic hepatitis C patients on Peg- Interferon Alpha-2a and Ribavirin therapy. A prospective cohort study. Hepatitis Center DHQ teaching hospital Sahiwal from July 2013 to June 2014. We studied 100 patients of chronic HCV infection with baseline level of TSH,T3 and T4. Baseline serum ALT and serum AST were also measured. Patients were put on Peg-Interferon Alpha-2a [180 ug] weekly and Ribavirin [800 to 1000 mg/d] for 24weeks. All patients were followed up for thyroid dysfunction at weeks 0, 12, 18 and 24. Out of 100 treated patients 65 were female and 35 were male. Fifteen [15%] patients developed thyroid dysfunction and out of these 15 patients [11 female [73.3%] and 4 male [26.7%]]. Ten [66.6%] out of 15 patients developed hypothyroidism and 5[33.3%] out of 15 patients developed hyperthyroidism. Seven [70%] out of 10 patients who developed hypothyroidism needed levothyroxine therapy. Two [40%] out of 5 patients who developed hyperthyroidism needed carbimazol therapy for their symptoms and disease control. All patients completed hepatitis C treatment with combined Peg-Interferon Alpha-2a and Ribavirin therapy

Vitamin D deficiency in patients presented in medical OPD with fibromyalgia

Objectives: To determine the prevalence of vitamin D deficiency in patients presented in medical OPD with fibromyalgia/body aches and pains

Study Design: A prospective observational cohort study

Place and Duration of Study: Medical OPD of DHQ teaching hospital Sahiwal from July 2013 to June 2014

Material and Methods: 120 patients 80[66.67%] female and 40[33.33%] male coming to medical OPD of DHQ teaching hospital Sahiwal complaining of body aches and pains and diagnosed as Fibromyalgia according to American College of Rheumatology [ACR] criteria. Patients were not suffering from systemic illness on examination. The reports of serum calcium, phosphate, alkaline phosphatase, CBC and ESR, were normal. Serum level of 25[OH] vitamin D was estimated by Enzyme Linked Fluorescent assay [ELFA technique] using commercially available kit VIDAS[R] 25[OH] vitamin D total [VITD]

Results: Out of 120 patients, 80[66.67%] were female and 40[33.33%] male patients. 56[70%] out of 80 female patients had vitamin D deficiency [<20 ng/mL] and 14[17.5%] out of 80 patients had vitamin D insufficiency [21-29 ng/mL]. 25[62.5%] out of 40 male patients had vitamin D deficiency [<20 ng/mL] and 8[20%] out of 40 male patients had vitamin D insufficiency [21-29 ng/mL]. So, out of 120 patients 81[67.5%] had vitamin D deficiency [<20 ng/mL] and 22[18.33%] patients had vitamin D insufficiency [21-29 ng/mL]. Total 103[85.83%] out of 120 patients were suffering from vitamin D deficiency/insufficiency [<30 ng/mL]. 17 [14.13%] out of 120 patients had sufficient levels of vitamin D [>30 ng/mL]

Conclusion: Fortification of food especially milk and ghee should be done with vitamin D to improve vitamin D deficiency state in the people. Government health authorities should ensure this practice for decreasing the bony problems in the community