Incidence of retinopathy in chronic Hepatitis C patientstreated with pegylated interferon alpha 2a and ribavirin combination therapy

The objective of this study was to determine the incidence of retinopathy in chronic hepatitis C patients treated with Pegylated interferon alpha 2a and Ribavirin. This descriptive case series study was conducted in Medical Unit II of the Jinnah Hospital Lahore from September 2012 to February 2013. One hundred chronic hepatitis C patients visiting Medical Unit II outpatient department fulfilling inclusion criteria were selected for this study via non probability purposive sampling. Patients were started on pegylated interferon and ribavirin combination therapy. Subjects were subjected to dilated eye fundoscopic examination at the start of therapy and then after three months of the therapy. One hundred patients were included in this study. Out of these 100 patients 5% developed retinopathy whereas fundus examination was normal in rest of the patients. Interferon therapy can lead to retinopathy. Periodic fundoscopic examinations help in early detection and prevent progression to permanent visual loss

Alanine aminotransferase / Aspartate aminotransferase ratio reversal and prolonged prothrombin time: a specific indicator of hepatic cirrhosis

Both ALT/AST ratio reversal [AST/ALT>1] and prolonged prothrombin time are separately related to hepatic cirrhosis. Ratio reversal means that in normal individuals ALT is more than AST and thus ALT/AST>1 but with development of cirrhosis AST becomes, ALT and so AST/ALT>1 or ALT/AST<1. This study was conducted with the idea that prolonged prothrombin time and reversed [AST/ALT>1] ratio together can prove a more specific indicator with a high positive predictive value for the detection of hepatic cirrhosis in patients of chronic liver disease than either of the two alone. Method: This is a comparative cross sectional study. The data of hepatitis B and C patients was collected from the general medical ward and medical out patient department. Clinical and Ultrasonographic features, detected by a single ultrasonologist, were used to diagnose cirrhosis. Patients who were alcoholic were excluded from the study as alcohol itself causes ALT/AST ratio reversal. To avoid laboratory errors and variations the facilities of only a single specific laboratory were used for this study. The sensitivity and specificity of ALT/AST ratio reversal along with positive predictive value were calculated. Then prolonged prothrombin time [PT] and reversed ratio together were used and the results of these two groups were compared. It was found that the reversal of ratio alone is 88% specific as an indicator of hepatic cirrhosis and almost 70% sensitive and have a positive predictive value of 94.5%. The statistical significance test based on z-test for difference of proportion yields: z=6.96 with a p value=0.0000. On the other hand, the prolonged PT and ratio reversal are 98% specific and 53.9% sensitive with a positive predictive value of 98.2%. z-test for difference of proportion yields here: z=6.23 with a p value=0.0000. ALT/AST ratio reversal alone has a high sensitivity and the combined effect of these two parameters increases the specificity as compared to either of the two alone. The high positive predictive value here shows that almost all the patients with reversed ratio and prolonged PT will have cirrhosis