Drug induced hepatitis; does hepatitis b and hepatitis c co-infection increases the risk during anti tuberculosis chemotherapy

We evaluated whether HBV +ve and HCV +ve patients are at high risk for developing drug induced hepatitis than control subjects during treatment for tuberculosis with standard short course regimens. Observational cohort study. This study was conducted at Department of Medicine, Liaquat University of Medical and Health Sciences Jamshoro from May 2008 to May 2011. All newly diagnosed active tuberculosis patients were included in the study population and they were further screened for hepatitis B surface antigen and HCV antibodies. All patients were divided into three groups. One having no co-infection with hepatitis B and Hepatitis C and was taken as control group, second group was co-infected with hepatitis B and third was co-infected with hepatitis C. short course anti tuberculous regimen was started and patients were followed for six months. One hundred and twenty eight tuberculous patients were divided into three groups. 92 in control groups without any co-infection with hepatitis B and C, 10 were HBV +ve and 26 were HCV +ve. During follow up 24 developed drug induced hepatitis, 8[38.33%, n = 24] in control group, 2[8.33%, n = 24] in hepatitis B group and 14[58.33%, n = 24] in hepatitis C group. These findings suggest that treatment for tuberculosis in HCV seropositive patients is a risk factor for the development of hepatitis exacerbation and HBV seropositive patients shows no any increased risk of hepatitis exacerbation

Serum lipoproteins and chronic hepatitis C infection; importance of inverse relationship

To determine the serum lipid profile in patients with chronic HCV infection and correlation between serum lipid levels and liver histology. Descriptive study was carried out in Medical Unit I of Liaquat University Hospital Jamshoro Hyderabad, from September 2007 to August 2009. Convenience sampling was used and 30 patients were selected. Positive PCR test for HCV, non diabetic patients and non cirrhotic patients were included in this study. All the patients were selected from the medical OPD. Clinical examination performed and then blood tests were done. Serum lipid profile were determined in all participants after an overnight fast of 12 h. TC, TG, and HDL-C was measured enzymatically with commercial kits [Olympus System Reagent, Hamburg, Germany] by the use of an automated analyzer. The body mass index [BMI] was calculated in accordance with the formula of weight [kg] divided by height2 [m2]. Selected patients were called in the ward and biopsy was done via Trucut needle and the specimen was fixed in formalin. The biopsies were used to calculate the degree of steatosis [0-3] and fibrosis by METAVIR score. A total of 30 patients were selected for this study. Out of these 19 were males and 11 females. The patients were divided in three groups. Patients with chronic HCV infection were found to have significantly lower levels of serum TC, HDL-C and LDL-C than normal adults values. Steatosis was present in significant number of patients [36.67%]. However, steatosis was not correlating with fibrosis [p>0.005]. Hypolipoproteinemia and steatosis are important factors which are associated with chronic hepatitis C

Cirrhotic patients; incidence, of UGI bleeding factors and esophageal varices

To determine the frequency of upper GI bleeding and its predicting factors and esophageal varices in the patients with liver cirrhosis disease admitted at medicine ward of Isra university hospital. Prospective and observational study. Isra university hospital. March 2012 to August 2012 [six months]. Containing 100 patients, mean age was 45.8, and all the patients with cirrhosis disease were included in this study with liver cirrhosis disease. All patients were under went endoscopy and Frequency of upper GI bleeding and varices presentation and classification according to grade were noted. All the 100 patients were selected on the basis of presenting liver cirrhosis disease. Male were more found than the female with the mean age 45.8. Mostly cirrhotic patients were found with HCV positive and upper GI bleeding were noted in [40%] of the cases. With the endoscopic finding mostly patients were noted in II - III grad of esophageal varices and according to child pug classification majority of patients was noted in class "C" In addition, thrombocytopenia and red wale markings along with the presence of large sized varices were associated with the presence of esophageal varices. In the conclusion of this study we found majority of the cirrhotic patients with HCV, Esophageal varices and thrombocytopenia are the important factors of upper GI bleeding. Knowledge and etiology of this manuscript may helpful in the prevention of oesophageal varices and upper GI bleeding

Chronic hepatitis ''C''; a dermatologic perspective

To find spectrum of various dermatological manifestations during hepatitis "C" virus infection in local population of hyderabad. This descriptive study was conducted in medicine department of Isra University Hospital Hyderabad from January 2011 to June 2012. A total of 325 anti-HCV positive patients were enrolled. All patients were subjected to detailed history, careful clinical examination of skin by a dermatologist to diagnose skin disease. All data was analyzed using statistical package SPSS 14.0. A total of 325 HCV positive patients [61% males and 39% females] were enrolled in this study. Mean age was 43 [SD+10 years], ranging from 15 to 78 years. About 41% had one or more dermatologic manifestations. Pruritis was the leading manifestation found in 11%, lichen planus [oral and cutaneous] was next to be found in 6.7% patients and hyperpigmentation in 5.2% patients. Urticaria [acute and chronic] was next counting in 5.23%. Jaundice, alopecia and vitiligo were seen in 4.9% each. Dry skin and interferon injection site erythema were observed in 4.6% patients each. Cutaneous vasculitis was noticed in 3.6% each, while photosensitivity, psoriasis and Raynaud's phenomenon were seen in 1.8%, 2.5%, 1.5% patients respectively. Dermatological manifestations are very common in patients with chronic HCV infection and when confronted with a suspected skin lesion, patient should be screened for it. Epidemiological studies are essential to determine the real prevalence of other dermatoses during course of HCV infection