Chronic hepatitis C--treatment results in northern India.

BACKGROUND: There have been major innovations in the treatment of chronic hepatitis C in the last decade. The course of the disease is variable and host, viral and environmental factors can influence the disease course and response to various treatment protocols. Data on the therapeutic response among north Indian patients with chronic hepatitis 'C' is limited. Therefore, we analysed our results of treatment among patients with chronic hepatitis C. MATERIAL & METHODS: A total of 55 patients with chronic hepatitis C were treated. Forty nine patients completed treatment with either interferon alpha 2b alone (n = 12) or combination of interferon alpha 2b and ribavarin (n = 37). All the patients were seropositive for anti HCV and, HCV RNA. All of them had elevated ALT and histological features of chronic hepatitis. Response to treatment was evaluated as end treatment response (ETR) i.e. HCV RNA not detected at end of treatment and sustained response (SR) i.e. HCV RNA not detected six months after completing the treatment. Adverse effects were also recorded. RESULTS: Overall, ETR was documented among in 69% of the patients and SR in 45% patients. Sustained response rate was higher with combination therapy as compared to interferon alone i.e. (51% vs 25%). Sustained response with induction dosing was 57%. Treatment had to be stopped in 3 patients due to major side effects like psychiatric disorders (2) and hypotension (1) and 3 patients were lost to follow up during the course of therapy. CONCLUSION: Sustained virological response with combination therapy is better than with interferon alone. Induction dosing improves the sustained virological response further. Major side effects with the antiviral drugs necessitating drug withdrawal is infrequent.

Hepatitis C--knowledge & practices among the family physicians.

BACKGROUND: Hepatitis C virus (HCV) is an important cause of end stage chronic liver disease worldwide. There is plethora of informations on hepatitis C virus in the recent hepatology related periodicals. However, family physicians to whom such patients initially present, should be aware of various aspects of hepatitis C virus infection. Therefore, the present study evaluated the information on hepatitis C virus known to practicing family physician in the state of Punjab. MATERIAL & METHODS: Nine hundred thirty six family physicians were randomly selected from 7 districts of Punjab and were mailed a questionnaire designed to test their knowledge on HCV, its transmission, clinical presentation, complications and treatment. In addition, questions were asked to assess commonly employed mode of therapy for short duration illnesses and the practice of reusing syringes/needles. All question had unequivocal answer. The questionnaire reply was anonymous. RESULTS: Only 28% (n = 262) doctors returned the questionnaire. The response to different sections of questionnaire was variable. Seventy six percent doctors (n = 176) were aware that HCV is parenterally transmitted. 18% (n = 41) doctors were still reusing needles and syringes. Fifty eight percent (n = 134) doctors considered hepatitis C as a common cause of acute viral hepatitis. Only 72% (n = 166) of doctors knew about the relevant tests for diagnosis of hepatitis C. CONCLUSIONS: Despite having knowledge about parenteral route of transmission of HCV infection, a sizeable proportion of family physicians in the Punjab state continues to reuse needles and syringes. Information on the virology, clinical presentation, diagnostic tests and management approaches were lacking among a substantial proportion of family physician. Therefore, awareness about HCV need to be increased among the practicing physicians.

Methylprednisolone acetate versus oral prednisolone in moderately active ulcerative colitis.

BACKGROUND: Patients with active ulcerative colitis are treated with corticosteroids. We compared the efficacy and safety of intramuscular depot preparation of methylprednisolone acetate with oral prednisolone in the treatment of moderately active ulcerative colitis. DESIGN: Open labeled, randomized, prospective, four-month study. METHODS: 40 patients with moderately active ulcerative colitis (activity index 150-220) were randomized into two groups. Group A (n=21) received methylprednisolone acetate (80 mg intramuscularly once weekly for 6 weeks). Group B (n=19) received oral prednisolone (40 mg/day) in a 'tailing-off' regimen. In addition, patients in both the groups received sulfasalazine. Patients were followed up at 1, 2, 3, 4, 8, 12 and 16 weeks. The primary measure of therapeutic response was activity index. An index of <150 was considered as clinical remission. Secondary efficacy was assessed by subjective evaluation of acceptability of treatment by the patient. RESULTS: After one week of treatment, the decrease in mean activity index was significantly more with oral prednisolone (p<0.05), and five 5 patients (23.8%) in Group A and 12 (63.2%) in Group B were in clinical remission (p<0.05). However, after 2 weeks and beyond, the mean activity index and the number of patients with clinical remission were comparable in the two treatment groups. CONCLUSIONS: Methylprednisolone acetate as a depot preparation and oral prednisolone are equally effective in inducing remission in patients with moderately active ulcerative colitis. Though symptomatic improvement is quicker with oral prednisolone, the remission rate with the two drugs was similar after 2 weeks of treatment.

Coexistence of celiac disease and ulcerative colitis.

Coexistence of celiac disease and ulcerative colitis has been reported from Western countries. We report two patients, a 30-year old man and a 16-year old boy, who presented initially with features of celiac disease and later developed ulcerative colitis.

Multiple mucosal bridges in the oesophagus after sclerotherapy for varices.

An oesophageal mucosal bridge can occur due to acquired causes and also due to congenital anomalies. A patient with mucosal bridge of the distal oesophagus following sclerotherapy with absolute alcohol is reported.

Self-reported disease awareness--a questionnaire survey of ulcerative colitis patients.

OBJECTIVE: To evaluate patient knowledge about ulcerative colitis and relate this to their socio-demographic characteristics. METHODS: 145 patients with ulcerative colitis were given a two-sectioned awareness questionnaire in a language they understood. The first section, which tested disease awareness, consisted of 16 items. Awareness was classified as very low (< or = 4 correct answers), low (5-8), medium (9-12) and high (13-16). The second section contained 11 questions pertaining to general opinions and views about the disease. RESULTS: Nine (6.2%) participants had very low level of awareness, 107 (73.8%) low level, 29 (20%) medium, and none high disease awareness. Only disease duration influenced disease awareness significantly. Age, sex, marital status, occupation and education level had no relation to the level of awareness. A majority of patients resorted to use of alternative medicines during their disease course; however, with increasing awareness the use of other types of therapy was reduced. Drug compliance had significant association with disease awareness. CONCLUSIONS: Our patients with ulcerative colitis had poor disease awareness. Since awareness affected treatment compliance, the study emphasizes the need for better education of the patients and their family about the disease.

Intrapulmonary vascular dilatation in portal hypertension due to cirrhosis of liver.

BACKGROUND: Intrapulmonary vascular dilatation in patients with portal hypertension due to chronic liver disease has been reported mainly from Western countries. METHODS: Fifty in-patients with portal hypertension due to cirrhosis of the liver were subjected to contrast-enhanced two-dimensional echocardiography in order to detect the presence of intrapulmonary vascular dilatation. Their arterial blood oxygen saturation was measured. The patients, including 37 men, were aged mean 43.5 years; 30 had alcoholic cirrhosis and 20 postnecrotic cirrhosis. Twelve patients were in Child-Pugh, class B and 38 in class C. RESULTS: None of the 50 patients was cyanosed or had clubbing. Their mean pO2 was 83.2 mmHg. None had evidence of intrapulmonary vascular dilatations. CONCLUSION: Intrapulmonary vascular dilatation was not observed in our patients with liver cirrhosis. However, the sensitivity of contrast-enhanced echocardiography for this purpose needs to be reviewed.

Cronkhite Canada syndrome.

Cronkhite Canada syndrome is an acquired non-familial syndrome characterised by diffuse gastrointestinal polyposis with alopecia nail dystrophy and hyperpigmentation. There is chronic diarrhoea and protein losing enteropathy. The etiology of this syndrome remains obscure. The rarity of the case prompts this case report.

Spider angiomas in the gastrointestinal tract.

Spider angiomas are cutaneous manifestations of endocrine imbalances in cirrhosis. We describe unusual cases of massive bleed from spider angiomas in the oral cavity and colon in association with cirrhosis of liver.

Role of azathioprine in severe ulcerative colitis: one-year, placebo-controlled, randomized trial.

OBJECTIVE: To investigate the efficacy of azathioprine in treating patients with severe ulcerative colitis. DESIGN: One-year, randomized, placebo-controlled trial. SUBJECTS: 83 patients with severe ulcerative colitis were enrolled. Fifty patients who relapsed within two months on corticosteroid withdrawal were randomized into two groups. The azathioprine group received oral sulfasalazine (6-8 g/day), oral prednisolone (1 mg/Kg/day) and oral azathioprine (2 mg/Kg/day). The placebo group received oral sulfasalazine (6-8 g/day), oral prednisolone (1 mg/Kg/day) and placebo. Corticosteroids were tapered over 12-16 weeks. RESULTS: Five patients (2 in azathioprine group, 3 in placebo group) dropped out of the study. Three patients in the azathioprine group had side effects. The number of patients going into complete remission and partial remission was not significantly different in the two groups. The proportion of relapses in the azathioprine group was lower than in the placebo group (p < 0.05). CONCLUSIONS: In patients with ulcerative colitis, azathioprine had no effect in achieving remission, when given in combination with prednisolone; however, it lowers the proportion of relapses. Side effects like pancreatitis and hepatitis are mild and respond promptly to drug withdrawal.

Hereditary pancreatitis.

Hereditary pancreatitis is a rare cause of chronic pancreatitis and has been mainly reported in western literature. It is inherited in an autosomal dominant manner. In this report, we present our data on two affected members in a family from Punjab, North India.