Time for change: conventional interferon regimes should not be the standard of care for management of Pakistani genotype-3 in chronic Hepatitis C

The aim of the present study was to determine the efficacy and side effect profile of conventional interferon alpha-2b plus ribavirin for treating chronic hepatitis C genotype-3 infections in Pakistan. The study was conducted on treating 220 treatment-naAve individuals at KRL Hospital with conventional interferon given for 6 months. Both the response and side effects were analyzed using simple descriptive statistics. Out of total cohort, 84.92% [169 out of 199] achieved end of treatment response [ETR] while 63.31% [126 out of 199] achieved sustained virological response [SVR]. Leukopenia, gastrointestinal and miscellaneous systemic complaints were the most common adverse effects. In the context of a low ETR and SVR but a similar side effect profile as that of pegylated regimes, conventional therapy needs to be replaced with peg-interferon as the treatment of choice

Iatrogenic post biopsy hemobilia with pseudoaneurysm

Hemobilia is defined as bleeding into the biliary tree from an abnormal communication between a blood vessel and bile duct. It is an uncommon cause of upper gastrointestinal hemorrhage and iatrogenic most of the times. We report a case of hemobilia secondary to percutaneous liver biopsy presenting with classical Quincke's triad in a young lady which was treated with combined biliary balloon sweep thrombectomy and transarterial embolization for complete resolution of symptoms

Pre-treatment predictors of response for assessing outcomes to standard treatment in infection with HCV genotype 3

To determine the role of pre-treatment predictors of response in assessing outcomes to standard treatment in HCV genotype 3. Observational study. Department of Medicine, KRL General Hospital, Islamabad, from December 2004 to December 2006. All patients with positive anti-HCV and PCR genotype 3a were recruited and written and informed consent was taken. Patients were treated with standard Interferon plus Ribavirin therapy [IFN alpha-2a, 3MU t.i.w 24 weeks plus Ribavirin 1000-1200 mg/day] for 6 months. The effect of pre-treatment factors influencing outcome i.e. age, gender, weight, baseline ALT, necroinflammatory grade, fibrosis and steatosis on the final outcome were further analyzed by univariate logistic regression analysis. Response rates to standard Interferon plus Ribazole therapy were studied in 190 patients. The end-of-treatment complete response [EOTCR] was seen in 81% [n=155] of the patients, whereas 17% [n=33] were non-responders [NR]. Sustained viral response [SVR] was seen in 58% [n=112] patients and 24% [n=45] were relapsers. SVR was higher in patients without steatosis [OR = 2.52, 95% CI = 1.356-4.71, p = 0.04]. Higher SVR was seen in patients weighing less than 65 kg, as compared with weight > 65 kg [OR= 2.277, 95% CI = 1.246-4.161, p = 0.007]. The other variables were not found to be significantly associated with improved SVRs. Out of the studied predictors, body weight and presence of steatosis, were statistically related to treatment outcome. Pre-treatment host factors can predict response to treatment that can help in individualizing treatment and patient selection and optimize treatment outcomes

Response rates to standard interferon treatment in HCV genotype 3A

Chronic Hepatitis C infection infects almost 130 to 170 million or approximately 2.2-3% of world's population. HCV is one of the main causes of chronic liver disease leading to progressive liver injury, fibrosis, cirrhosis and liver cancer. It is also one of the leading indications for liver transplantation worldwide. The objective of the study was to determine the response of treatment with standard Interferon and Ribazole in treatment na‹ve Hepatitis C infected patients. This quasi-experimental study was carried out at the Department of Medicine, KRL General Hospital Islamabad, from January 2003 to January 2005. A total of 250 patients were enrolled in this descriptive study. All patients were anti HCV positive, PCR positive for HCV RNA and had 3a genotype. A non-probability purposive sampling technique was applied to collect data. After taking a written and informed consent; specially designed performa containing the patient profile, family transmission, and baseline laboratory values was filled. Patients were treated with a set protocol of Interferon plus Ribavarin therapy [IFN alpha 2a, 3 mIU thrice weekly for 24 weeks plus Ribavarin 1,000 to 1,200 mg/day] for six months. Chi-Square tests were used to analyse the data. Primary end point was a sustained virological response [SVR] that is response assessed after six months of completion of treatment. Response rates to standard Interferon plus Ribazole therapy were studied over two years period. Out of the total of 250 patients, 60 patients were excluded; as 30 patients did not meet inclusion criteria, 23 patients were lost to follow. Seven patients declined treatment. Out of the190 patients, 155 [81.6%] achieved End of Treatment Complete Response [EOTCR] whereas 35 [18.4%] were nonresponders [NR]. These 155 patients, who showed complete response were followed for six months after the treatment to assess sustained viral response, which was seen in 112 [72.25%] patients whereas 43 [27.7%] were relapsers. Response rates were co-related with gender, baseline ALT and necro-inflammatory stage assessed by liver biopsy, probable risk factors and family history. Management of Hepatitis C with genotype 3a, with standard Interferon and Ribazole for six months showed lower SVR compared to that reported in previous international and local data

Heavy smoking induces hyperlipidemia in healthy males

The relationship of cigarette smoking with the body mass index, adiposity and plasma lipid levels of 88 male subjects was assessed. The level of cholesterol, L.D.L. and Triglycerides was found to be significantly higher in subjects who were heavy smokers. Daily smokers had lower B.M.I., higher cholesterol and lower skin fold thickness compared to controls. It is concluded that smoking - an important risk factor for coronary heart disease - amplifies the risk due to its independent effect on the lipid profile. Smokers differ from non smokers with lower B.M.I and skin fold thickness but the overall difference is unimpressive p = 0.21. Daily smokers had a significant increase in the mean cholesterol of 30 percent over non smokers. Triglycerides were raised by 29 percent. L.D.L. - C was 3.57 +/- 1.12 L.D.L. /H.D.L. ratio was also increased. All these changes were more marked in the heavy smokers. This explains why in prospective analysis increasing mortality and morbidity among smokers cannot be attributed to confounding variables. It is concluded that an overall similarity between different smoking groups exists mainly in terms of dyslipidaemia and constitutional differences though present are not significant