Hepatitis C; early prediction of therapy response in patients and the benefits of treatment extension in non responders

Hepatitis C virus [HCV] has infected about 200 million individuals across the world and is known as the major cause of liver disease. Viral load measurement at early stages of the therapy in Hepatitis C patients is believed to be a more effective tool to predict the sustained virological response [SVR]. The primary aim of the present study was to evaluate whether the decline in viral load of HCV at early stages of the therapy may predict the treatment response. Another objective was to see the benefits of therapy extension in non-responders. Descriptive, analytical study. Shalamar Hospital Lahore. November 2010 to October 2013. Four hundred and thirty patients, chronically infected with different genotypes of Hepatitis C virus were treated with Interferon alpha 2b plus Ribavirin [IFN alpha-2b + RBV]. Viral load was assessed at day zero, week four, in the mid time of therapy and at the end of therapy. The treatment duration was extended 12-24 weeks [according to HCV genotypes] in non-responders. The patients with <2 MIU/ mL viral load at day zero, able to drop >/=2 log viral load at week-4 or showed no virus at the time of half therapy completion, exhibited better response. The extension of therapy was more beneficial for those non-responder who had <0.05 MIU/mL viral load at the end point of therapy than those who had >/=0.05 MIU/mL at that stage. The viral load detection at early stages of the therapy will be useful in clinical practice. Moreover, the patients with <0.05 MIU/ mL viral load at the end of therapy are suitable candidates for the therapy extension

Effect of different factors; interferon alpha plus ribavirin combination therapy

To determine the effect of different factors on the efficacy of treatment in Hepatitis C patients. Descriptive, analytical study. Shalamar hospital Lahore. October 2010 to May 2013. A total of 254 Hepatitis C patients infected with different genotypes of Hepatitis C virus [HCV] were treated with Interferon alpha 2b plus Ribavirin [IFN alpha-2b+RBV] for 6-12 months according to viral genotype. Before starting the treatment, the presence of HCV and its quantity in the patient was done by real-time PCR. HCV Genotyping was done by multiplex PCR. The patients with <40 years of age or had less than 2 million international units per milliliter basic viral load [<2 MIU/ml] showed better end of therapy [EOT] and sustained virological response [SVR] than >/=40 years of age or >/=2 MIU/mL basic viral load. The response of males to Interferon therapy was better than females. The patients infected with HCV genotype 1 or 4 exhibited lower response than those infected with other than 1 or 4 genotype. The affect of other variables like alcohol, diabetes, hypertension, smoking, injection brand change or missing the injection during therapy were also remarkable in the present study. With proper management of the factors mentioned in the present study efficacy of the treatment can be improved

Importance of polymerase chain reaction in diagnosis of pulmonary and extra-pulmonary tuberculosis

Pakistan ranks 8[th] on the list of 22 high-burden tuberculosis [TB] countries in the world according to the World Health Organization's [WHO] Global Tuberculosis Control 2009. Including other reasons the main cause is improper and late diagnosis of the disease. PCR may play an important role to control the disease with its rapid, sensitive and specific diagnosis. But in Pakistan due to lake of knowledge about this latest technique we are not using this technique appropriately. Clinicians still trust on conventional methods of TB diagnosis, which are time consuming or insensitive. The present study was arranged to highlight the importance of PCR in TB diagnosis in pulmonary and extra-pulmonary cases and its comparison with conventional methods. Samples obtained from 290 patients of suspected TB [pulmonary or extra-pulmonary] were subjected to ZN smear examination, LJ medium culture and PCR test by amplifying 541bp fragment of Mycobacterium tuberculosis complex genome. The present prospective study is performed at Shalamar Hospital Lahore from November 2008 to November 2010. A distinctly difference was observed in the test results done by PCR and other conventional techniques in pulmonary or extra-pulmonary tuberculosis samples [p<0.001]. The sensitivity of different tests was 68.62% for PCR, 26.90% for LJ medium culture, and 14.14% for ZN smear examination [p<0.05]. However, there was no significant difference between different tests as for as specificity was concerned. PCR test sensitivity in pulmonary and extra-pulmonary clinical samples was 78.34 and 61.76% respectively, being significantly higher [p<0.05] when compared with sensitivity of other tests. The mean detection time for M. tuberculosis was 25 days by LJ medium culture and less than 1 day by smear examination and PCR test. PCR test is more sensitive than ZN smear examination and LJ medium culture for the diagnosis of TB in pulmonary and extrapulmonary clinical samples

Significance of appropriate sampling in the diagnosis of tuberculosis [TB] - a comparison of different techniques

After years of decline, tuberculosis [TB] has re-emerged as a serious public health problem worldwide causing significant mortality and morbidity in developing countries like Pakistan, where the estimated incidence of TB is 181 per 10000. The present prospective study was conducted in Shalamar Hospital Lahore from January 2007 to October 2009. The objective was to compare the PCR results of specific site samples and blood of the same TB patient to see the validity of PCR results based on blood samples. Clinical samples obtained from 205 patients of suspected TB [pulmonary or extra-pulmonary] were subjected to ZN smear examination, LJ medium culture, and PCR test by amplifying 541 fragment of Mycobacterium tuberculosis complex genome. A highly significant difference was seen in the test results clone on samples obtained from specific site according to disease and blood samples of the same patient infected with pulmonary or extra-pulmonary tuberculosis. The sensitivity of different tests was found to be significantly different, which was 67.32 percent for PCR test, 27.81 percent for LJ medium culture and 12.20 percent for ZN smear examination. However, there was no significant difference between different tests as far as specificity was concerned. PCR test sensitivity in pulmonary and extra-pulmonary clinical samples was 77.15 and 61.6 percent respectively, being significantly higher, when compared with sensitivity of other tests. The mean detection time for M. tuberculosis was 24 days by LJ medium culture and less than 1 day by .smear examination and PCR test. We concluded that the PCR test is more sensitive than ZN smear examination and LJ medium culture for the diagnosis of TB in pulmonary and extra-pulmonary clinical samples. To get more accurate results PCR for TB diagnosis should be done on specific site samples. Blood samples are not appropriate for the diagnosis of TB by PCR when the PCR is clone on TB genomic DNA

Production technology and post harvest processing of medicinal herbs and spices of soeio-economic importance

Medicinal herbs constitute as one of the major group of plants with recognized socio-economic value, which is not only ethnobotanically important but also pharmacologically useful. In the international market, opportunities are emerging day by day for the trade of medicinal plants to fetch foreign exchange for the country. India, China, USA, Canada and Brazil are leading producers in this sector earning billions of dollars from their export products. Luckily, Pakistan is also a biodiversity rich country with natural wealth of useful medicinal plants especially medicinal herbs and spices, not only in the mountainous areas but also in the great plains of the Punjab and Sindh. Inspite of their use in kitchen, they can also be used against various diseases like cancer, diabetes, heart diseases and liver disorders, e.g. hepatitis and AIDS. At present, our local market is unable to fulfil the required demands of the population. Raw material is therefore also imported from China, India, Afghanistan and European countries. Unavailability of proper production technology and suitable area of cultivation, post-harvest processing, market constraints and low economic returns as compared to major cereal crops, are the main problems in cultivation of these herbs and spices. In this paper the authors have reported their experiences about improved cultural practices, production technology and post-harvest processing techniques for the introduction and domestication of medicinal herbs and spices cultivation on large scale. The production technology and post-harvest processing techniques have been mentioned to improve cultivation and domestication of Gul-e-Baboona [Matricaria chamomilla], Coriander [Coriandrum sativum], Pudina [Mentha piperita], Niazbo [Ocimum basilicum], and Kandiari [Silybum marianuni]. Following these practices and proper timing for cultivation, farmers of low land area can earn appreciable income from their land. Moreover, they can grow these herbs and spices in their homes [indoor and outdoor], kitchen gardens, and on marginal lands as single crop, as intercrop and also as rotational crop with other cereal crops

TB case management by doctors in district Rajanpur

Multi drug resistant tuberculosis [MDR-TB] is the alarming threat of the day. Main causes of this era are the sub optimal, incomplete and inadequate therapy. Poor criteria of diagnosis are also the causative towards MDR-TB. National TB programs [NTP], short course chemotherapy [SSC], directly observed treatment short course [DOTS] programs are arranged to overcome these things. But in poor areas, the poor living and nutritional conditions, restless hardworking, incomplete therapy due to poverty, poor diagnostic criteria and poor prescriptions due to lack of knowledge of SSC, DOTS and NTP programs are the burning candle on the way of MDR-TB. To verify these parameters a survey of the Private Medical Practitioners [PMPs] having qualification at least M.B.B.S in the poor and backward area of Pakistan [District Rajan Pur] was done with a data sheet containing 20 different questions related to TB case management. Only 3.84 percent practitioners were familiar with culturing, 85.72 practitioners termed cough as a major symptom of TB, 28.57 percent practitioners had weight machine for children out of which 7.14 percent were in working condition and there was no weight machine for adults, more than 46 percent practitioners claimed to familiar with NTP guidelines of treatment but no one was following the standar NTP guidelines of treatment. Duration of initial intensive phase and continuation phase therapy varied from 2 to 6 months and 1 to 10 months respectively. No doctor had any record of TB patients