The aim of this study was to describe the genetic characteristics of Pakistani patients infected with hepatitis C virus (HCV) in relation to IL28B polymorphisms and its association to interferon and ribavirin treatment response. A total of 220 patients, infected with HCV were enrolled, out of which 100 were responders and 120 were nonresponders. The whole blood samples were collected to extract viral RNA and genomic DNA. PCR following the restriction fragment length polymorphism method was used to genotype IL28B rs12979860, rs8099917, and rs12980275 polymorphisms. Liver biopsies and HCV genotyping were performed in nonresponder patients. The rs12980275 AA genotype exhibited significant correlation to treatment response and was found in 62% of the responders and 37.5% of nonresponder patients, whereas AG genotype was noticed frequently in the nonresponder group (P < 0.0001). The rs12979860 CT and rs8099917 TT genotypes were found in 74% and 66% of the responders as compared to 58.3% and 50.8% in nonresponder patients (P = 0.001 and P = 0.032) respectively. HCV 3a genotypes were detected in 50.8% of the nonresponder patients. No significant association was detected between liver biopsy findings and IL28B SNPs (P > 0.05). The results showed the significant association of rs12980275 polymorphism with treatment response in HCV patients followed by rs12979860 and rs8099917. This is the first report describing the association of rs12980275 with response to HCV treatment from Pakistan. These findings may help in predicting the outcome of pegylated interferon and ribavirin treatment in HCV patients, and may reduce the side effects and cost of treatment in predicting non-responder patients.

Autoimmune hemolytic anemia (AIHA)-an immunological disease resulting from red cell hemolysis caused by circulating autoantibodies against antigens on red cell membrane. Positive direct antiglobulin test (DAT) always exist in association with AIHA and form basis for its serologic diagnosis. The objective of our study was to determine clinical presentation and etiological pattern in autoimmune hemolytic anemia at a tertiary care hospital. Study Design: Descriptive, cross-sectional study. Setting: Medical unit I of Liaquat University Hospital Jamshoro / Hyderabad. Period: 1 st January 2010 to 30 th June 2010. Patients and Methods: We enrolled 125 patients of either sex and ages from 13 to 81 years for evaluation of possible AIHA. We screened patients by performing direct and indirect antiglobulin tests (DAT and IAT) and cold agglutinin titre (CAT) levels. Pregnant women or those with history of blood transfusion in previous three months, DAT positive patients due to Rh and ABO incompatibilities in neonates and IAT positives cases in Rh-negative pregnant women were excluded. Results: We evaluated 125 patients who were DAT positive autoimmune hemolytic anemia. About 93(74.4%) were females and 32(25.6%) males with female to male ratio of 2.9:1. The mean age of our patients was SD ± 36.73 ± 9.32 years. Our patients commonly presented, generalized weakness in 33(26.4%), pallor of face and extremities in 22(17.6%) and breathlessness in 20(16%) respectively. On clinical examination, moderate to severe anemia was noted in 100(80%), splenomegaly in 40(32%), hepatosplenomegaly in 28 (22.4%) and no visceromegaly in 30(24%) of our cases. We found 35(28%) with primary and 90(72%) patients due to secondary causes of AIHA. The connective tissue disorders, renal failure and hematological disorders were common causes of secondary AIHA in this study. Conclusion: Our study showed females in their thirties presented with generalized weakness, pallor of face and extremities and breathlessness. Majority had secondary AIHA due to consecutive tissue disorders, renal failure and hematological disorders as underlying causes. Doctors must be cautious regarding whole blood transfusion as means for treating mild to moderate anemia.

Hyponatraemia is the most common electrolyte anomaly and is associated with significant morbidity and mortality. Patients with severe hyponatraemia often present to acute medical units with non-specific symptoms which can progress to overt neurological manifestations. There are many causes of hyponatriaemia, the most common being drug-induced causes, particularly thiazide diuretics, and the Syndrome of Inappropriate ADH Secretion (SIADH). Initial assessment should include a careful evaluation of the patient’s volume status, which helps to identify the most likely cause. This article utilises a recent case which presented to our AMU to illustrate the importance of a careful and systematic assessment of patients presenting to hospital with hyponatraemia. The new vasopressin receptor antagonists are explored as an option for the management of severe hyponatraemia.

Background: Pancytopenia is an important hematological problem encounteredin our day-to-day clinical practice. The aim of our study was to evaluate clinical features andetiological pattern of pancytopenia at tertiary care settings in Abbottabad. Methods: Thisprospective study was conducted at Northern Institue of Medical Sciences (NIMS) and AyubTeaching Hospital Abbottabad from 25th August 2009 to 31st July 2010. A total of 85 patientsfulfilling the criteria of pancytopenia were randomly selected by time-based sampling.Pancytopenia was diagnosed by anemia (hemoglobin ≤ 10.0g/dl), leucopenia (WBC ≤ 4.0×109/L)and thrombocytopenia (platelets ≤ 150×109/L). All data has been entered and analyzed by SPSSversion 10.0. Results: Out of 85 patients, 62(72.94%) were males and 23(27.05%) females withM to F ratio of 2.69:1. The mean age (±SD) of males was 30.20±15.42 years, while that of females35.12±16.31 years (p=0.20). Among clinical features, anemia and generalized weakness werethe commonest (97.64%), followed by shortness of breath (88.23%). Majority 54(63.52%) hadnon-malignant disorders responsible for pancytopenia. Overall, the most common cause ofpancytopenia was aplastic anemia noted in 30(35.29%) cases, followed by megaloblastic anemia15(17.64%) and hypersplenism in 13(15.29%). Conclusions: On conclusion, aplastic anemiawas the most common cause of pancytopenia in our study predominantly affecting young adultmales. It

Background objective: Hyponatremia is not uncommon complication of liver cirrhosis and may affect hospital mortality. This study was aimed to determine frequency and outcome of hyponatremia in liver cirrhosis patients. Patients and Methods: The cirrhotic subjects were assessed for hyponatremia while outcome measured in relation to hyponatremia and its severity. Data was analyzed in SPSS 16.0 and frequencies as well as percentages calculated for hyponatremia. Results: Out of one hundred liver cirrhosis patients, 65% were males and 35% females. Mean age ±SD of overall cirrhotic subjects was 40.79±7.83. Hyponatremia was identified in 72% (51% males and 21% females) patients. The mean ± SD for sodium level in overall population was 129.73±8.35 while 119.92±3.61 in hyponatremic cirrhotic patients. Conclusion: Dilutional hyponatremia is a frequent finding in liver cirrhosis patients.