Association of obesity with rapid virological response in patients with chronic hepatitis C

Objective: To determine the association of obesity with rapid virological response in patients with chronic hepatitis C on antiviral therapy

Methodology: In this prospective cohort study patients suffering from chronic hepatitis C who required treatment were included after getting ethical approval and informed consent. Patient's weight and height was measured and body mass index [BMI] was calculated. Patients were divided into 2 groups; group 1 having BMI <30 and group 2 having BMI >30 in equal numbers. All the patients were put on weekly pegylated interferon plus ribavirin in fixed divided doses. PCR was done at the completion of 4 week to check for rapid virological response [RVR]. After completion of study these 2 groups were compared to see whether any significant association exists between BMI and RVR. RVR was also stratified among age, viral load and gender to see their effect as these are potential effect modifiers

Results: There were 140 [56.3 %] male and 110 [43.7%] female patients with male to female ratio of 1.2:1. Mean age of the patients was 39.78 +/-9.85, while mean BMI was 27.40 +/-5.86. Overall the RVR was achieved in 53.2% of the patients. Frequency of RVR was 77[61.6 %] in non-obese patients as compared to 56[44.8%] in obese patients with a p value of 0.008

Conclusion: Obesity is significantly associated with poor RVR in patients with chronic hepatitis C

Association between baseline parameters and end of treatment response to combination of conventional interferon and ribavirin in patients with chronic hepatitis C

To study the association between baseline parameters and end of treatment response [ETR] to conventional interferon treatment in patients with chronic hepatitis C. This retrospective analytical study was conducted in Gastroenterology department of Lady Reading Hospital Peshawar from January 2012 to June 2012. A total of 222 patients with chronic hepatitis C, on combination of conventional interferon and ribavirin therapy were included in the study who reported with ETR. Various baseline parameters included sex [male vs. female], age [< 40years vs. >40years], weight [<70kg vs. >70kg], viral load [<800000IU/ml vs. >800000IU/ml] and ALT quotient [<3 vs. >3]. These variables were compared with ETR to see for any significant association. Two hundred and twenty two patients were included in the study out of which 94[42.3%] were male and 128[57.7%] were females. 121[54.5%] of the patient achieved ETR while 101[45.5%] failed to achieve ETR. Among various variables tested weight <70kg [59% vs. 43%] and ALT Quotient >3 [70% vs.50%] were significantly associated with ETR with a p value of 0.01 and p value of 0.013 respectively while there was no statistically significant association between other parameters and ETR. High baseline ALT and baseline low body weight are significantly associated with better ETR. Among these weight is a modifiable factor and obese patients should be advised to lose weight before embarking them on anti viral therapy in order to improve their chances of viral clearance

Hypocalcemia with bony metastases in prostate cancer

A 65 year old man presented with a two-month history of low back pain and fatigue and urinary symptoms over the preceding month. He was found to have had a hepatomegaly and a large nodular prostate on rectal examination. Investigations revealed a normal full blood count and renal profile, raised alkaline phosphatise and Prostate Specific Antigen [PSA], and low serum Calcium. A bone scan was performed which revealed widespread bony metastases in the axial and appendicular skeleton resulting in a 'superscan', consistent with prostatic metastases. We recommend that calcium levels be checked in all patients with prostate cancer and metastatic bone disease as this may have a bearing on their symptoms and the use of biphosphonate therapy

Effect of hypoproteinemia on treatment outcome in children with acute lymphoblastic leukemia

Malnutrition is prevalent on large scale in hospitalized patients which increases morbidity and mortality, reduces the effectiveness of medical treatment in our hospitals and impairs the quality of life significantly. Early diagnosis and treatment of malnutrition is gaining the significance day by day. A prospective study was carried out to assess the effects of hypoproteinemia malnutrition on the treatment outcome of children with acute lymphoblastic leukemia. One hundred and sixty three patients with Acute Lymphoblastic Leukemia [ALL] below the age of 14 years with L1 and L2 FAB morphology were included in this study. Treatment protocol used was FBM. Patients were classified according to Waterlow classifications of malnutrition [1976]. Group-I, as Well-Nourished children [WNC] and Group-II as Mal-nourished children [MNC]. Percentages in both groups were found out with respect to total expired, Relapses and completed treatment. In Group-I [WNC] 50 [81.96%] completed treatment and alive, 5 [8.19%] relapsed and 6 [9.8%] expired. In Group-II [MNC] 31[30.39%] completed treatment and alive,8 [7.84%] relapsed and 63 [61.76%] expired. Overall, in WNC group-I 50[30.67%] completed treatment and alive, 5 [3.07%] relapsed and 6[3.68%] expired. In MNC group-II 31 [19.02%] completed treatment and alive, 8 [4.91%] relapsed and 63 [38.65%] expired. Hypoproteinemia affects treatment outcome in children with acute Lymphoblastic Leukemia

Pre existing malnutrition and treatment outcome in children with acute lymphoblastic leukaemia

To assess the effects of pre-existing malnutrition on the treatment outcome of children with acute lymphoblastic leukaemia. One hundred and sixty three patients with Acute Lymphoblastic Leukaemia [ALL] below the age of 14 years with L1 and L2 FAB morphology were included in this study. Treatment protocol used was FBM. Patients were classified according to Waterlow classifications of malnutrition [1976].Group-I, as Under-Nourished children [UNC] and Group-II as Well-nourished children [WNC]. Percentages in both groups were calculated with respect to total expired, relapses and completed treatment. In Group-I [UNC] 46% completed treatment and were alive, 9.8% relapsed and 45% expired. In Group-II [WNC] 59% completed treatment and were alive, 21.3% relapsed and 19% expired.Overall, in WNC group 13.5% completed treatment and were alive, 8% relapsed and 7.3% expired. In UNC group 28.8% completed treatment and were alive,6% relapsed and 27% expired. Pre-Existing malnutrition adversely effects the treatment outcome in children with Acute Lymphoblastic Leukaemia [ALL]

Does weight for age have prognostic significance in children with acute lymphoblastic leukemia?

To assess the effects of nutrition status [Weight for Age] of leukemic children on the treatment outcome. A prospective study from May, 1996 to June, 1999. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. One hundred patients with Acute Lymphoblastic Leukemia [ALL] below the age of 14 years with L1 and L2 FAB morphology were included in this study. Treatment protocol used was FBM. Patients were classified according to waterlow classifications of malnutrition [1976]. Group-I, as Under-Nourished children [UNC] and Group-II as Well-nourished children [WNC].Percentages in both groups were found out with respect to total expired, Relpses and completed treatment. In Group-I [UNC] 44.5% completed treatment and are alive, 9.5% relapsed and 46% expired. In Group-II [WNC] 59.5% completed treatment and are alive, 5.5% relapsed and 35% expired. Overall, in WNC group 22% completed treatment and are alive, 2% relapsed and 13% expired. In UNC group 28% completed treatment and are alive, 6% relapsed and 29% expired. Our data was not significant [P=0.791] to prove the hypothesis that the malnutrition [Anthropometrical] adversely effects the treatment outcome in Pakistani children with Acute Lymphoblastic Leukemia [ALL]. Weight for age does not has prognostic significance in children with Acute Lymphoblastic Leukemia [ALL] and should not be considered as prognostic factor