PREDICTIVE VALUE OF EARLY VIRIOLOGICAL RESPONSE FOR SUSTAINED VIRIOLOGICAL RESPONSE IN CHRONIC HEPATITIS WITH CONVENTIONAL INTERFERON THERAPY.

BACKGROUND: Hepatitis is a major public health problem in Pakistan due to its strong association with liver failure and hepatocellular carcinoma. In Pakistan, conventional interferon therapy along with Ribavirin is favoured especially in Government funded programs for treatment of Hepatitis C, over the more expensive Pegylated Interferon and Ribavirin combination therapy as recommended by Pakistan society of Gastroenterology and GI endoscopy due to its favourable results observed in genotype 3 which is the dominant genotype of this region. Objective of our study was to assess the virological responses with standard interferon therapy and to determine the predictive values of early virological response (EVR) for Sustained Virological Response (SVR) in chronic hepatitis C patients treated with standard interferon therapy. METHODS: A cross sectional study was conducted on patients with chronic hepatitis C having received standard interferon and ribavirin therapy for six months. EVR and SVR were noted for analysis. Positive and negative predictive values of EVR on SVR were calculated. RESULTS: Out of the total sample (N = 3075), 1946 (63.3%) patients were tested for EVR. 1386 (71.2%) were positive while 560 (28.8%) were negative while 516 (16.8%) were tested for SVR. Two hundred and eighty-five (55.2%) were positive while 231 (44.8%) were negative. EVR and SVR tested were n=117. Positive predictive value of EVR on SVR was 67.1% and negative predictive value was 65.8%. Statistically significant association between EVR and SVR was determined with Chi square statistic of 11.8 (p-value < 0.0001). CONCLUSION: EVR is a good predictor of response of patients to standard interferon and ribavirin therapy. In the absence of an EVR, it seems imperative to stop further treatment. Virlogical responses with conventional interferon therapy are comparable to those of pegylated interferon therapy so adoption of conventional INF therapy is justified in terms of its cost effectiveness especially in resource constrained nations like Pakistan.

Diagnosis, Management And Prevention Of Hepatitis C In Pakistan 2017.

AIMS AND OBJECTIVES: Since the advent of direct acting antiviral agents, there is a revolutionary change in the management of HCV infection. Newer drugs with different mechanism of action are being introduced and are expected to be available in coming few months in Pakistan as well. The main purpose of the guideline is to review and induct the latest research in field of HCV infection in Pakistani perspective so that our healthcare professionals can apply the new recommendations in timely and judicial manner. Target groups of guidelines are general physicians treating hepatitis C, hepatologists and gastroenterologists. Other beneficiaries of these guidelines are public health institutions of Pakistan, which provide free treatment to deserving patients under National Hepatitis Prevention and Control Program and Pakistan Bait-ul- Mal Program. METHODOLOGY: These guidelines are based on the review of National consensus practice guidelines: Diagnosis, Management and Prevention of Hepatitis C Pakistan 2009. Published data in National and International Journals searched with the help of Google search and pub med, and 2015-16 guidelines of HCV by AASLD, EASL, APASL and WHO. Local studies are preferably added with references to enhance the Pakistani perspective. Evidence was also taken from published studies. Recommendations have been based upon evidence from national publications on the subject and scientific presentations at national liver meeting as well from experts' personal experience and opinion.

Multidrug-resistant tuberculosis in Rawalpindi, Pakistan.

INTRODUCTION: Multidrug-resistant (MDR) tuberculosis (TB) strains are resistant to isoniazid and rifampicin. Clinical characteristics, drug susceptibility patterns, and outcomes of MDR-TB patients treated at Holy Family Hospital, Rawalpindi, Pakistan, were studied from January 2007 to April 2010. METHODOLOGY: Thirty diagnosed patients (60% male and 40% female) of MDR pulmonary TB were included. Each patient was treated according to WHO guidelines and followed for two years. Clinical characteristics (age, gender, literate or illiterate educational status, employment status, and income), drug susceptibility testing (DST) reports, and outcome (cured, treatment failure, default, and died) of each patient was noted. RESULTS: Mean patient age was 36.2 ± 15.4 years. In total, 60% patients were illiterate, 60% employed, 60% had income < Rs 5000 (42 Euro per month), 73.3% lived in an overcrowded residence, 60% were smokers, and 83.3% had taken anti-tuberculosis therapy previously. DST of MDR-TB strains for ethambutol, pyrazinamide, and streptomycin showed high resistance ( > 60%). Except for ofloxacin and ciprofloxacin, < 20% resistance was noted in second-line anti-tuberculosis agents. Overall, 10% of patients were cured, 40% died, 20% had treatment failure, and 30% patients defaulted. CONCLUSION: Pulmonary MDR-TB in Rawalpindi, Pakistan, is common in young males, poverty related circumstances, and has poor outcome. DST shows high resistance to first- line anti-tuberculosis agents and quinolones.

Anti-HCV antibody positivity of various sections of Pakistani patients.

OBJECTIVE: To determine the anti-HCV antibody status of various sections of the Pakistani population and patients as reported in various Pakistani studies. STUDY DESIGN: A meta-analysis. PLACE AND DURATION OF STUDY: Department of Medicine, Rawalpindi Medical College and Allied Hospitals, Rawalpindi, from July 2007 to July 2008. METHODOLOGY: Data pertaining to anti-HCV antibody status of various sections of the Pakistani population and patients was collected from studies published till July 2008. To note anti-HCV antibody status, 15 groups of subjects like liver disease patients, general blood donors, adult screening, and community prevalence etc. were identified. The frequency of total and anti-HCV antibody positive subjects of each group was noted. Chi2 was used as test of significance for comparison wherever appropriate. RESULTS: Data from 183 studies was collected; 1004391 subjects anti-HCV antibody status was retrieved. 4.27% (n=42982) of these were anti-HCV antibody positive. Major bulk of patients with liver disease (56.9%), 2.71% of general and 10.39% of professional blood donors groups were positive, (p < 0.05). Positivity in community and adult screening was 11.52 and 6.29% respectively. CONCLUSION: According to the studies in consideration; 2.71% of Pakistani general blood donors and major bulk of liver disease patients are anti-HCV positive. Community based anti-HCV positivity is 11.52%.

A 12 years audit of upper gastrointestinal endoscopic procedures.

OBJECTIVE: Evaluation of upper gastrointestinal (GI) endoscopy in terms of indications, diagnostic efficacy, and diseases diagnosed. DESIGN: Retrospective, observational case series. PLACE AND DURATION OF STUDY: DHQ Teaching Hospital, Rawalpindi, from March 1990 to December 2001. SUBJECTS AND METHODS: Patients who underwent upper GI endoscopy in 12 years were included. Upper GI endoscopies were performed according to standard protocol. Endoscopic diagnoses were based on widely accepted criteria. RESULTS: Of the 8481 patients, 4935 (58.2%) were female and 3546 (41.8%) male. Mean patient age was 40.5 years. Dyspepsia (42.6%), upper GI bleed (32.8%), and evaluation of chronic liver disease (10.2%) were common indications of the procedure. An endoscopic diagnosis was possible in 82.6% patients. Varices, gastritis, duodenitis, and combined lesions were common endoscopic diagnosis. Gastritis and duodenitis were most frequent causes of upper GI bleed. We noted more gastric ulcers compared to duodenal ulcers. Females had significantly more normal endoscopies, p-value=0.02. CONCLUSION: Upper GI endoscopy is an effective procedure. Dyspepsia evaluation is commonest indication for upper GI endoscopy in our patients. Etiology of upper GI bleed, and incidence of duodenal ulcer compared to gastric ulcer in our patients are different than described in literature. Females have significantly more normal endoscopies.