Introduction: Typhoid fever remains a problem in developing countries, including Pakistan. The emergence of multidrug-resistant and, since 2016, of extensively drug-resistant cases is a continuous challenge for health care workers. The COVID-19 pandemic is making management more difficult. Methodology: In the present study, a total of 52 confirmed cases of typhoid have been studied during 2019. Detailed clinical features, complications and, lab findings were studied. Typhoid culture and sensitivity were recorded and patients were treated accordingly. Patients were asked about risk factors to aim at informing prevention. Results: Out of the 52 having blood culture positive for Salmonella Typhi 47 (90.4%) and Salmonella Paratyphi 5 (9.6%), 4 (7.7%) were sensitive to first-line (Non-resistant), 11 (21.2%) MDR and 37 (71.2%) patient were XDR. One case was resistant to azithromycin. Nausea, vomiting or, abdominal pain was present in 12 (23%), abdominal distension present in 9 (17.3%), abdominal tenderness in 8 (15.4%), hepatomegaly in 10 (19.2%) and, splenomegaly in 22 (42.3%).There were ultrasound abnormalities in 58% of patients and GI complications in 19% of patients. No significant difference was found in clinical findings and complications between resistant and non–resistant cases. Only 23-27% of patients were aware of typhoid prevention and vaccination measures. Conclusions: The increasing prevalence of resistance and higher degree of complications seen in typhoid fever raises the concern further about prevention and effective infection management in the community as well as clinical settings. Moreover, judicial use of antibiotics is much needed in developing countries like Pakistan.
Objective: To determine the efficacy of dual (sofosbuvir and ribavirin) and triple therapy (sofosbuvir ribavirinpegylated interferon) for treatment of hepatitis C. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Medicine, Combined Military Hospital, Lahore, from Nov 2014 toMar 2017. Methodology: A total of 182 consecutive patients with age ≥18 years and positive HCV RNA by polymerasechain reaction were included, while patients with haemoglobin of <10 g/dl, albumin <2 g/dl, platelet countof <100/uL, creatinine clearance of <60 mL/min or liver disease caused by non-hepatitis C related causes wereexcluded from study. Results: Total 129 (70.8%) were treated with dual and 53 (29.1%) with triple therapy. Amongst patients withgenotype 3 (158/182), the overall sustained virological response at 12 weeks (SVR 12) was 94.4% in patients withdual therapy while it was 97.3% with triple therapy. In non-cirrhotic patients it was 95% in treatment naïve and100% in treatment experienced group. While in cirrhotic patients with genotype 3, SVR 12 with dual therapy was83.3% (p=0.331) and 88.9% in treatment naïve and treatment experienced patients respectively, while it was 100% in both groups with triple therapy. SVR 12 for genotype 1 (21/182) was 100%, both for dual as well as for triple therapy. Haematological side effects dominated the clinical picture with 11.5% suffering from anaemia. Conclusion: Both dual and triple therapy were effective in patients with hepatitis C with acceptable level of sideeffects, genotype 3 being the most predominant genotype.
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