Hematologic adverse effects and efficacy monitoring in chronic Hepatitis C patients treated with interferon and ribavirin combination therapy

180 million people are affected by chronic Hepatitis C Virus infection globally and more than 50 million in South East Asia. Combination of Interferon and Ribavirin is the current anti-HCV therapy in practice and is associated with certain hematologic adverse effects. In this concurrent observational study the incidence rate of major hematologic adverse effects and efficacy outcomes of Interferon and Ribavirin combination therapy was evaluated in 288 chronic hepatitis C patients at Lahore General Hospital. Levels of Hb, TLC, and Platelets counts were monitored for hematologic adverse effects monitoring, whereas, ALT, AST and bilirubin levels were monitored for efficacy. PCR was done at week 4, 12 and 36 for therapeutic success evaluation. A significant reduction in Hb levels [p<0.05] was observed after week 4, 8 and 12 of therapy. Frequency of anemia increased in both genders with body weight <65kg and platelet count <150,000/mm3. End Treatment Response [ETR] was achieved in 64.5%. Anemia was the major side effect of the combination therapy particularly in the males. Higher ETR was observed in patients who achieved RVR and were <50 years of age

Early childhood milk and milk products intake - maternal perceptions and practices

The prevalence of micronutrient deficiencies in young children has a profound effect on their immune system, growth and mental development. However, many micronutrients deficiencies in children such as calcium can be prevented. This research has explored the perceptions and practices of mothers, residing in Karachi, regarding milk and milk products [MAMPs] intake in children of age 2-5 years, in order to find out the amount of MAMPs in their diet and the factors affecting such intake. This is a qualitative exploratory study. Semi structured, in-depth interviews were conducted. Eighteen mothers whose children's age were 2-5 years old were purposively recruited from three daycare centers of three different socioeconomic status areas of Karachi. The MAMPs intake of children in three different socioeconomic areas of Karachi was in accordance with 2006's, American Academy of Pediatrics recommendations for requirements, i.e. 2 cups per day of Milk/Dairy for 2-4 years old children. However, the type of MAMPs and children's preferences differs considerably. The most preferred MAMPs among children of age were yogurt and plain milk. The preferences for MAMPs in children were mainly determined by their peers, mother's ethnicity and media advertisements. Most of the mothers did not prefer giving MAMPs in several common childhood illnesses due to prevailing misconceptions. It was also explored that maternal ethnicity plays considerable role in selecting and combining various food items mainly fish with MAMPs. Recognizing the MAMPs intake of children and their mother's perceptions and practices can help researchers to better understand children's preferences for different MAMPs and the factors influencing their intake. Food policies and recommendations related to MAMPs in children can be evaluated for their relevance to children's ecological determinants to address the issues related to growth and development in early ages.

High prevalence of mild hyperhomocysteinemia and folate, B12 and B6 deficiencies in an urban population in Karachi, Pakistan

To find out the prevalence of hyperhomocysteinemia, and deficiencies of folate, vitamin B6 and vitamin B12 in an urban population in Karachi, Pakistan. In a pre and post experimental study, eight hundred and seventy-two apparently healthy adults [aged 18-60 years; 355 males and 517 females] were recruited from a low-income urban locality in East of Karachi from February 2006 to March 2007. Fasting venous blood was obtained. Serum was analyzed for folate and vitamin B12. Plasma was analyzed for pyridoxal phosphate [PLP, coenzymic form of B6] and total homocysteine. A group of vitamin-deficient individuals [n=194] was given 3-week supplementation with folic acid [5mg/day], methycobalamin [0.5mg/day] and pyridoxine hydrochloride [vitamin B6, 50 mg/day]. After supplementation, serum/plasma levels of folate, vitamin B12, PLP and homocysteine were again determined. Prevalence of hyperhomocysteinemia [>15micromol/l] was 32%. Similarly percent values of folate deficiency [<3.5ng/ml], vitamin B6 deficiency [PLP<20 nmol/l] and vitamin B12 deficiency [<200pg/ml] in the study population were 27.5%, 33.7% and 9.74%, respectively. Hyperhomocysteinemia was associated with male sex, folate deficiency, vitamin B12 deficiency [OR [95%CI], 8.3[5.7-12.1]; 2.5[1.76-3.58]; 2.6[1.5-4.5], respectively]. A 3-week supplementation with folic acid, methycobalamin and pyridoxine hydrochloride in vitamin-deficient subjects decreased plasma homocysteine levels by 37%. High prevalence estimates of folate, vitamin B12, and vitamin B6 deficiencies appear to be the major determinants of hyperhomocysteinemia in a low income general population in Karachi

Identifying needs and barriers to diabetes education in patients with diabetes

To assess the needs, awareness and barriers to diabetes education for self management and to facilitate the initiation of an education programme promoting self care among diabetics and their families. A qualitative study was conducted among adult diabetics attending outpatient clinics in a tertiary care teaching hospital in Karachi, Pakistan. Semi-structured interviews were conducted on 27 subjects [11 men; 16 women] to identify dominant themes and priority issues. Participants displayed great deal of variation with respect to level of knowledge and motivation for education. Most believed that diabetes was caused by stress. Family was perceived to be a source of positive support. Relative ease of adherence to pharmacological regimens as compared to diet and exercise was reported. Participants expressed frustration at chronicity of disease and fear of developing certain specific complications and inheritance by their children. Barriers to enhancing knowledge included 'No need for further information', distance from training institutions and other priorities. Knowledge, beliefs and fears about diabetes, family influence and accessibility of healthcare, affects management behaviours and learning. Understanding needs and expectations of people with diabetes is essential in initiating and improving the outcomes of education programme for diabetes self care

Diabetes and hypertension: public awareness and lifestyle-findings of a health mela

To determine the frequencies of diabetes, hypertension and their established lifestyle risk factors and to assess the level of awareness about diabetes and hypertension amongst persons attending a health mela at the Aga Khan University Hospital [AKUH], Karachi. Design: Cross-sectional, analytical study. Place and Duration of Study: One-day health mela held at AKUH, Karachi. Subjects and A total of 264 participants were administered structured questionnaire to obtain demographic data and perceptions about diabetes and hypertension after taking verbal informed consent. Height, weight, blood pressure and random blood glucose were measured. Overall frequency of type 2 diabetes was 13.6%, impaired glucose tolerance [IGT] 8.3% and hypertension 24%. Frequency of diabetes and hypertension in both men and women increased with increasing age [p<0.001] and body mass index [p=0.02]. Over half the men and women with type 2 diabetes [53% and 57% respectively] and 42% men and 60% women with IGT also had hypertension. Diabetes and hypertension were correctly defined by 52% and 37% subjects respectively and this was significantly associated with educational level [p=.001]. Lack of physical exercise was observed in 59% participants, while 53.6% men and 67.5% women were overweight/obese. As compared to women, men used more additional salt [p=0.03] and had more outside meals [p<0.001] and snacks [p=0.01]. High frequencies of diabetes, hypertension, obesity, unhealthy nutrition and lack of exercise were observed in the study population. Emphasis on health education is needed to increase public awareness of the warning signs and risk factors of these common conditions