Interferon and ribavirin associated depression in HCV patients and role of selective serotonin reuptake inhibitors

To determine the frequency and severity of depression associated with antiviral therapy of Hepatitis C Virus [HCV] infection and effect of selective serotonin reuptake Inhibitors [SSRIs] to treat these depressive symptoms. Type of Study: Observational Analytical study. Place of Study and Duration: The study was conducted at Psychiatry, Medicine and Pathology department of Combined Military Hospital Sialkot Pakistan from February 2009 to July 2010. All the patients in this study were suffering from HCV infection and were managed with Interferon [3 m.i.u. s/c thrice weekly] and Cap Ribavirin [400 mg bid] for six months. Patients were assessed by Hospital Anxiety and Depression Scale [HADS] - Urdu Version and Beck's Depressive Inventory [BDI] Scores after twelve weeks of antiviral therapy. Depressed patients were managed with selective serotonin reuptake inhibitors [SSRIs] for six weeks and again evaluated on HADS and BDI Scores. Response to SSRIs was defined as complete response, partial response and no response. A total of 105 patients were studied out of which 75 were male and 30 were female with mean age 29.4 years. Out of these 54 [51.43%] patients developed depression and this tendency to develop depression was not related with the age and sex of the patients. The mean HADS and BDI scores before and after treatments with SSRIs were compared for significance and it was quite significant. There was not a single patient who did not show response to SSRIs. Depression is frequently associated with antiviral therapy of HCV RNA viraemia with interferon and SSRIs have proved an effective and safe remedy in these patients

Frequency of tuberculosis in haematological malignancies and stem cell transplant recipients

To assess magnitude of tuberculosis [TB] in patients suffering from various haematological malignancies and stem cell transplant [SCT] recipients. Descriptive study. Oncology Department, Combined Military Hospital, Rawalpindi, and Armed Forces Bone Marrow Transplant Centre, Rawalpindi, from July 2001 to December 2002. Patients suffering from various haematological malignancies treated between July 2001 and December 2002 were included in the study. The hospital records and out-patient follow-up charts were reviewed for demographic information, diagnosis, clinical presentation, laboratory investigations, radiological and pathological examinations, sites involved in TB, methods of diagnosis, number and type of anti-tuberculosis drugs given and response to treatment. During the study period a total of 213 [including 25 allogeneic stem cell transplant [SCT] recipients] patients with different haematological disorders were treated. Out of these, 34, including 4 SCT recipients developed tuberculosis. Overall frequency of TB was 16%. Median age of TB patients was 33.5 years [range 8-80 years]. Median time between diagnosis of haematological disorders and tuberculosis was 21 weeks. Sites of involvement by TB were lung [18], disseminated [6], lymph node [5], pleura [2], spine [2] and pericardium [1]. Three of the patients died of TB; one undiagnosed, second with multi-drug resistant TB and the third soon after the start of anti-tuberculosis treatment while remaining 31 cases responded to anti-tuberculosis treatment. Tuberculosis is a major problem in immunocompromised patients and there is need to establish guidelines for TB chemoprophylaxis in our setup