Frequency of depressive and anxiety symptoms among patients on interferon and pegylated interferon

Background: Chronic Hepatitis C [CHC] is highly prevalent in Pakistan. Current standard treatment is Interferon alpha/ Peginterferon with oral ribavirin. Interferon therapy is associated with development and worsening of depressive symptoms in CHC patients and to determine the frequency of depressive and anxiety symptoms among patients on treatment with interferon/ Pegasus

Methods: This cross sectional study was conducted at OPD of Liaquat University Hospital Hyderabad during a period of 4 months [from July2013 to October2013]. A sample of 120 patients aged 18-60 years, either currently receiving interferon/ Pegasus treatment or had received that treatment during last 12 months was taken. Known cases of anxiety, depression and those suffering from other debilitating co morbid conditions like carcinoma and non-consenting were excluded. Ethical approval was taken from LUH ethical review committee. A Proforma was used to gather the data. The data collected were analyzed using SPSS version 20.0. Mean [+/-SD] were computed for quantitative variables. Categorical variables [such as gender and outcome variables i.e. anxiety and depressive symptoms] were measured in frequencies and percentages. Stratification was done with regard to age group and gender to see the impact of these on the outcome followed by application of chi-square test with P-value <0.05 taken significant

Results: Total 120 patients were included in the study and 119 completed the questionnaire. Male patients were 55.5%. Mean age of patients was 32.59 +/- 8.56 years [Range: 16-56 years]. Primary outcome i-e; frequency of depression and anxiety in patients on interferon were 77.3% and 70.6% respectively. [n=92] had depression. Frequency of depression of almost similar in both genders [77.3% in males and 77.4% in females; p value= 0.584], while anxiety was more in females than males [75% vs 68.2%; p value= 0.273]. Both psychiatric symptoms increased with increasing age from 16-26 years to 47-56 years of age [p values = 0.432 and 0.736 respectively]. Vast majority [86.6%] were treated with interferon while only 13.4% received the PEGylated interferon therapy. Patients treated with PEGylated interferon had less frequency of depression than those treated with interferon [62.5% vs 79.6%; p value= 0.131]

Conclusion: Depression and anxiety were found to be common in CHC patients who had been or are being treated with antiviral treatment leading to increased risk of morbidity and mortality. Screening for risk of depression, proper education and timely treatment through anti-depressant followed by close monitoring is mandatory to achieve success in antiviral treatment

Sero-prevalence of hepatitis C antibodies in the people visiting roadside barbers

Sharing of blades and shaving kits, especially unsterilized ones are known risk factors for the transmission of Hepatitis C. The objective of this study was to determine the prevalence of Hepatitis C antibodies reactivity among the patients admitted due to any medical condition and who have been visiting roadside barbers. This was a descriptive study conducted from July 2007 to June 2008 in the Medical Unit-111, Jinnah Postgraduate Medical Center, Karachi. The study was designed to include patient's demographics [age, occupation, marital status and education], clinical information and duration of the visits to roadside barbers with an approximate frequency of shavings per month. The patients with history of>3 visits to a roadside barber during the last six months were included in the study. Whereas, the patients with history of liver disease, blood transfusion, surgery, dental treatment, tattoo marks, intravenous drug use, on regular injectable medicine [like insulin, etc], multiple sexual partners and on haemodialysis were excluded from the study. A blood sample was collected at the time of admission and the screening for HCV-antibodies was done by Enzyme Linked Immuno-Sorbant Assay [ELISA]. A total of 184 male patients were included in the study. The mean age+ SD of the patients under the study was 33.8+13.2 years. The majority of study patients were uneducated and belonged to low socioeconomic group. Out of 184 patients, 70 [38%] were found to be HCV-antibodies reactive. In comparison to younger patients [age<40 years], the older patients as well as those with history of longer duration of visits to roadside barbers had high prevalence of HCV-antibodies reactivity, P.015 and P.02 respectively. There was no statistical significant difference for the prevalence of HCV-antibodies reactivity among the different socioeconomic groups, educational level and marital status. In the present study, it is concluded that the sharing of unsterilized shaving kits and used blades by roadside barbers are the main sources for the transmission of HCV. The transmission rate of HCV infection increases with the duration and multiple exposures for shaving

Tetanus: presentation and outcome in adults

Tetanus is still a common clinical entity, especially in developing countries. The purpose of this study was to evaluate the presenting features as well as the outcome of tetanus in adult patients admitted to the hospital. This was a hospital based descriptive study conducted at the Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates from Jan. 2003 to Dec. 2008. The study was designed to include demographics, clinical information and outcome observed in the patients admitted with clinical diagnosis of tetanus. Patients with malignancy, immunosuppression [AIDS/Drugs], significant cardiac dysfunction and renal impairment were excluded. The patients were treated as per the standard protocol for the management of tetanus. A total of 44 patients were enrolled into the study. The mean age+SD of the patients were 26.3+5.8 years and all of the study patients were males. Thirty six [81.81%] patients gave the history of injury prior to onset of the symptoms, whereas eight [18.18%] patients were unable to recall any history of injury. All the study patients were laborers working in construction companies except for four who were gardeners. Body stiffness/spasm, difficulty in opening the mouth, difficulty in swallowing, body pain, neck pain and backache were the main presenting complaints. The patients with upper limb injuries had shorter incubation period and more severe disease with high frequency of autonomous nervous system insufficiency. Overall, hospital stay was 46.6+11.4 days. Forty [90.9%] patients required mechanical ventilation. The mean+SD ICU stay was 26.4+5.8 days and on weaning all the ventilated patients required tracheostomy. Eight [18.18%] patients died as a result of ventilator associated complications [Pneumonia] and autonomic nervous system dysfunction. Tetanus still carries high morbidity and mortality rate despite the available advanced management facilities including ICU care. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients

Comparative analysis of disease activity in patients of chronic hepatitis B virus, with and without super-infection with hepatitis D virus; an experience at tertiary care centre

The hepatitis D virus super-infection contributes significantly to the morbidity and mortality of hepatitis B virus infection. The objectives were to describe the incidence of Hepatitis D virus and comparative analysis of disease activity in patients of chronic hepatitis B virus, with and without super-infection of hepatitis D virus. This Cross-sectional comparative study was conducted at Department of Medicine and Gastroenterology Clinic Jinnah Postgraduate Medical Centre, Karachi, Pakistan from February 2007 to July 2007. HBsAg positive patients who attended our Gastroenterology clinic were selected for the study. After screening for Anti-HDV these patients were segregated in to Anti-HDV positive and negative groups. Data was analyzed on SPSS 12. Eighty-four patients were selected. Seventy-three patients who fulfilled the inclusion criteria were enrolled into the study. Anti-HDV was positive in 23 [31.5%] patients. Among these 23 anti-HDV positive, HDV-RNA was detected in 15 [75%] patients. The differences of age, gender, marital status and area of residence whether rural or urban were not significant between the two groups. HBV-DNA was significantly suppressed in majority of anti-HDV positive patients [p=0.019]. Mean serum ALT levels were significantly higher in patients who had HDV infection [p=0.014]. HDV infection was common in this series of patients with a frequency of 31.5%. All patients of chronic HBV should be screened for HDV whether they are asymptomatic HBV carriers or have chronic active hepatitis particularly when they have raised serum ALT