Frequency and clinical course of hepatitis E in tertiary care hospitals

To find out the frequency of hepatitis E virus as a cause of acute hepatitis and its clinical course in hospitalized patients. Design: Cross-sectional hospital-based study. Place and Duration of Study: The study was conducted in two tertiary care teaching hospitals i.e., Khyber Teaching Hospital and PGMI Lady Reading Hospital, Peshawar [Pakistan] from January to December 2002. Patients and Amongst the total number of 1922 admitted patients, 148 had history of nausea, vomiting and jaundice and raised serum bilirubin with raised hepatic transaminases [ALT], were screened for HBV [hepatitis B virus], HCV [hepatitis C virus] and subsequently for HEV [hepatitis E virus]. Acute hepatitis A, autoimmune hepatitis and Wilson's disease were excluded by doing appropriate test as and when required. The patients with hepatitis E were then monitored by checking their serial transaminases on day 1,4,8 and day 18 or until their transaminases dropped to normal. They were also clinically assessed and followed-up. Amongst the total admission of 1922 patients during one year period, 148 had acute hepatitis and out of these, 21 patients [14.189%] suffered from hepatitis E. Seventeen patients were below the age of 40. There were increased number of cases during the late summer and early winter seasons. Majority of the hepatitis E patients recovered during the short follow-up period of two weeks. Two patients had fulminant hepatitis. A four months pregnant young female died of her illness despite intensive treatment. Hepatitis E virus is fairly common cause of acute hepatitis in hospitalized patients. Most of the patients are having a benign self-limiting illness

Effect of oral and inhaled cetirizine in mild asthmatic patients

The effect of an inhaled and oral HI antagonist has been compared in the same patients.We have compared the effect of a single dose of nebulised [1 ml - 10 mg /ml] and oral [15mg] cetirizine to a matched placebo in a double blind double blind double dummy cross over study in 10 atopic asthmatics with moderate airflow obstruction mean [sem] age 52 [5.22] years, mean predicted FEV1 59 [3.9%]. The data was analysed by applying the multiple Regression analyses and chi square statistical methods. There was no significant difference in the baseline FEV1 on three study days. The maximum mean percentage increase in FEV1 after placebo, nebulised and oral cetirizine were 11.7 [2.8]; 11.3 [5.5] and 21.8 [3.7] respectively. Significant bronchodilation was observed at 60 [P<0.02], 120 [P<0.02] and 180 minutes [P<0.05] after oral cetirizine compared to placebo. Four patients developed transient bronchocostriction after inhaled cetirizine. These results suggest the presence of a local histamine tone in the airways. Ordinary doses of currently available HI receptor antagonist have minimal bronchodilator and bronchoprotective activity. In severe persistent asthma, HI receptor antagonist have no significant clinical effect, however in moderate asthma clinical benefits of HI receptor antagonist are apparent. The participation of antihistamine in the allergic inflammation including asthma must be reexamined, since the effect of histamine are more widespread and further studies are needed to evaluate its role in the management of asthma