Proton pump inhibitors - over-prescribed in a rural community?

There are specific licensed indications for the use of Proton Pump Inhibitors [PPIs]. However it is over-prescribed globally. We performed a study to find out the uses and misuses of this expensive drug in our rural and financially poor population. Prospective survey of patients successively admitted in medical and surgical wards of a teaching hospital in rural setting. Two hundred fifty successively admitted patients over a month were interviewed. Of them 144 [58%] were females. Mean age was 42 years [range = 10-100 years]. Ninety [36%] were using PPIs for which there was a licensed clinical indication in 44 [49%], whereas 46 [51%] had no definite indications. Fifty three patients [59%] who were taking PPIs were either self prescribing or were prescribed by an unqualified medical practitioner. Of these, 34 [64%] did not appear to have a valid indication. Of the remaining, 15 patients were prescribed PPI by a specialist, and 22 by a qualified general practitioner. Over half of patients [51%] in our setting are using PPIs with no definite indication. Over 2/3 [64%] of those were prescribed either by unqualified practitioner or bought over-the-counter, had no licensed indication

Frequency of HCV infection and its genotypes among patients attending a liver clinic and voluntary blood donors in a rural area of Pakistan

To determine the frequency of Hepatitis C virus [HCV] infection and its genotypic distribution in a rural area of Sindh, Pakistan. Retrospective study of patients attending the Free Liver Clinic [FLC], and investigated for detectable HCV antibodies [n=1638], and those screened for HCV infection prior to voluntary blood donation [n=804] at a teaching hospital, located in rural Sindh. All patients had HCV antibodies tested by ELISA. A total of 1022 patients, who tested 'reactive' to HCV antibodies, and who could financially afford to have HCV RNA tested by PCR, had their results analysed. A total of 200 patients also had their HCV genotyped and analysed. Patients at FLC had a higher chance of being reactive for HCV antibodies, compared to voluntary blood donors [20% VS 14% - p = 0.004]. HCV RNA was detectable in 904/1022 [88%] patients. Among typeable genotypes, 125/166 [75%] had a single genotype, and 7 patients [4%] were infected with genotype 1, either alone [n=4] or in combination with 3a. One out of every five people tested in our FLC, and 14% of "healthy" voluntary blood donors were seropositive for HCV antibodies. Genotype 1 is very rare in our region

Non-B, Non-C Hepatitis as a cause of advanced chronic liver disease requiring medical admission at a rural centre in Pakistan

To study the frequency and mortality of hepatitis B and C negative chronic liver disease [CLD] at a rural tertiary centre in Pakistan. Data was collected retrospectively from the case notes of all the 176 patients consecutively admitted with advanced CLD in our medical ward during one year period. Patients, who were seropositive for hepatitis B and / or C, were separated from those who were negative for them, and the data was analysed. Thirty five patients [20%] were negative for both viral markers. They were more likely to die during the admission than those who were seropositive [11% VS 25% - p = 0.029]. A significant proportion of patients with CLD are negative for viral markers. These patients are at higher risk of mortality, and need testing for other causes of CLD as some of them may benefit from curative treatments available

Liver diseases: admissions and mortality in a medical ICU at a rural centre in Pakistan

To study the frequency of admissions, complications and death rates in patients with chronic liver disease [CLD] in a rural medical Intensive Care Unit [ICU]. Retrospective analysis of 174 consecutive admissions. Out of 174 consecutive admissions, 69 patients [40%] had background liver disease. However, 55 patients out of this total [32%] were admitted directly in ICU because of the features of complications of their liver disease. Twenty six out of fifty five [47%] died. Thirteen out of twenty six had signs of encephalopathy. Seven out of fifty five had more than one complications of liver disease-only one of them survived. Hepatitis C was the cause of liver-related deaths in 18/26 [69%]. CLD is the commonest cause of admissions [32%] in medical ICU-Hepatitis C being responsible for 69%. Liver disease and its complications were also the commonest cause of all deaths in medical ICU, of which Hepatitis C contributed 69%. Encephalopathy was the most common manifested complication of cirrhosis, causing highest mortality