Factors influencing the response of interferon therapy in chronic hepatitis C patients

To determine factors influencing response of interferon therapy in chronic hepatitis C patients. Descriptive, analytical study. Pakistan Medical Research Centre, Jinnah Postgraduate Medical Centre, Karachi, from January 1998 to December 2009. Patients of chronic hepatitis C treated with conventional interferon were retrospectively analyzed. End treatment response at 6 months for genotype 2 and 3 and one-year for genotype 1 and 4 was assessed. Sustained virological response was checked after 6 months of cessation of therapy. Non-compliant and incomplete follow-up cases were excluded. Factors influencing the response to therapy were analyzed by univariate and multivariate logistic regression analysis. A total of 932 cases received interferon therapy; 103 were lost to follow-up and were excluded. Treatment was completed in 829 cases; end treatment response was 74% [615 out of 829 cases]. Six months post-treatment follow-up was available in 492 cases. Sustained virological response was seen in 63% [308 out of 492 cases]. Univariate logistic regression analysis showed significantly better response in patients with < 40 years of age, body weight < 70 kg, normal platelet count, serum albumin > 4.0 grams, non diabetic patients and those with a normal alanine aminotransferase [ALT] at 1st month of therapy. Multiple logistic regression analysis showed that only age < 40 years was significantly important for sustained virological response. For conventional interferon therapy, age < 40 years is the best predictor for sustained virological response, however, better response can be achieved in patients with < 70 kg weight, normal platelet count, serum albumin > 4.0 grams, non-diabetics and patients having normal ALT at 1st month of therapy

Comparison of healing of duodenal ulcer with herbal medicine versus allopathic medicine

Proton pump inhibitors heal over 90% cases of duodenal ulcer but these are expensive. Many patients are reluctant to use allopathic treatment and therefore, use alternate herbal medicines to achieve the same results. There is no head to head comparison of the efficacy of herbal treatment with standard allopathic treatment available in the literature. To compare the healing rates of duodenal ulcer using either herbal drugs [Andamali + Susi + Qarheen] or allopathic medicines [proton pump inhibitor]. Endoscopically diagnosed cases of duodenal ulcer were assigned to two groups where one group received herbal medicine and the other received proton pump inhibitor for 4 weeks [Clarithromycin and Amoxicillin were added for a week for Helicobacter pylori positive cases]. Healing was checked on endoscopy at the completion of therapy. Complete blood count, liver function tests, urea and creatinine were done initially and at the end of therapy to see any adverse effects of the therapy. Other side effects were also noted during the study. A total of 42 endoscopically proven cases of duodenal ulcer were included in the study, 22 patients received proton pump inhibitor [group A] and 20 received herbal medicine [group B]. Seven cases [5 in group A and 2 in group B] were lost to follow up and were thus excluded from the study. Thirty-five cases [17 group A, 18 group B] completed the study. Out of these 35 cases, 29[82.85%] were males and 6[17.1%] females. Helicobacter pylori was present in 19[54.3%] cases [10 in group A and 9 in group B]. After 4 weeks of therapy, 16[94%] cases healed with proton pump inhibitors and 13[72%] healed in herbal medicine group. The difference in healing rates was not significant. Using proton pump inhibitors along with 2 antibiotics in the Helicobacter pylori positive cases, 9 out of 10[90%] showed healing of ulcer, while 7 out of 9[78%] cases in herbal medicine group who were positive for Helicobacter pylori, but did not receive antibiotics also showed healing. Regarding adverse effects, bitter taste in mouth was reported in 5[29%] and diarrhea in 2[12%] patients, receiving triple regimen in group 'A' against only 2[11%] patients who had similar complaints with herbal medicine. No significant change was observed in the hematological and biochemical parameters like CP, LFTs, urea and creatinine from the baseline to the end of therapy in both groups. Healing of duodenal ulcer is almost similar with both herbal and standard allopathic drugs; however, adverse effects were more common with allopathic drugs. Herbal medicine can be used to treat duodenal ulcer