Role of amantadine in treatment of chronic hepatitis C

Background: Interferon afla [IFN-alfa] is the only effective treatment for patients with Chronic hepatitis C. Forty percent of patients have an initial response to therapy. But most subsequently relapse. Amantadine, an antiviral agent, in addition ability, of preferably concentrating in liver, has shown a role in reducing hepatic inflammation and suppressing viral replication. The aim of this study was to assess the efficacy and safety Of amantadine for treatment of chronic infection with hepatitis C virus [HCV]. Design: Prospective study. Period: From January 2002 to Dec 2003, Setting: Allied Hospital, Faisalabad

Methods: Fifty patients either naive or interferon resistant, with age range of 18-65 years, were enrolled and treated with amantadine 100 mg orally twice daily for six month. Control groups included the same cohort followed of therapy for 12-18 month or during therapy with interferon. All patients were assessed for safety. Tolerance and efficacy at the end of every month during treatment was completed. Patients were followed up for an additional six month to assess durability of response. The primary end - point were loss of detectable HCV-RNA six month after cessation of therapy

Findings: Out of 50 patients treated for six months with amantadine compared to intervals without therapy or to interferon therapy, 17 [34%] had normal serum alanive aminotransferase [ALT] values and had cleared HCV RNA in serum by the end of treatment. The sustained virological response was found in 11 patients with an undetectable serum HCV RNA level six month after therapy Baseline low serum HCV RNA levels were associated with higher rates of Response. During the therapeutic trial, amantadine caused no potential treatment limiting side effects but had a good safety profile

Interpretation: Therapy with amantadine results in biochemical as well as virological response both in the naive and interferon resistant cases of chronic hepatitis C

Prevalence of retinopathy in hypertensive patients

Objective: The objectives of this study were to find out the prevalence of hypertensive retinopathy among hypertensive patients in this area of Pakistan and grading of hypertensive retinopathy at the time of examination according to the Keith-Wagener retinal changes classification for hypertension. Study Design: An observational study. Period: 5½ months Setting: Outdoor/emergency department as well as in medical unit - II of Allied Hospital, Faisalabad

Material and Methods: Three hundred consecutive patients with hypertension of either sex and between 20-85 years of age were examined. Opthalmoscopy was done after dilating the pupil with 1% Mydriacyl and retinopathy graded according to Keith-Wagener Classification

Results: Among these patients, 168 had the finding of hypertensive retinopathy, with overall prevalence of 56%. Out of these 168 patients, 70 had grade I, 75 had grade II, 18 had grade III and 05 had grade IV changes according to the Keith-Wagener Classification of hypertensive retinopathy. Among these 168 patients with hypertensive retinopathy, 64 were males and 104 were females, with overall prevalence in males 58.18% and in females 54.73%. It is found that prevalence of hypertensive retinopathy is maximum in patients with 50 years of age or above. The prevalence of hypertensive retinopathy increases with the duration of hypertension and is maximum in patients with duration of 10 years or more. Two hundred twenty five [225] patients were taking single drug and out of these 110 patients were found to have retinopathy with prevalence of 48.8%, 40 patients were taking combination therapy and out of these 34 patients were found to have retinopathy with prevalence of 86%. The remaining 35 hypertensive patients who had never taken medicine for their B.P control, out of these 35, 22 patients were found to have hypertensive retinopathy with prevalence of 62.8%

Conclusion: Prevalence of hypertensive retinopathy in our population is quite high, seen in both sexes and almost in all age groups. It increases with duration of the disease, higher in patient who are taking combination of drug as compared to those who were on single drug