Background: Sofosbuvir-Velpatasvir has a high efficacy in adult patients with chronic hepatitis C infection .In this study, we reported treatment outcome with this drug in children and younger adults in Pakistani population. Objective: To assess the efficacy and safety of Sofosbuvir-velpatasvir in treating HCV-infected children and young adults. Methods: This Interventional(Clinical trial) was done in Hepatitis clinic Jinnah Hospital, Lahore from April 10, 2021 to January 9, 2022.A total of 45 patients aged 6 to 18 years with detectable HCV RNA by PCR were registered. They were evaluated clinically. HCV genotyping was not done as Sofosbuvir – Velpatasvir is pangenotypic. All of the patients were given a single oral dose of Sofosbuvir-velpatasvir per day. Ribavirin was included for patients with compensated cirrhosis and for those who were treatment-experienced .Clinical assessment, CBC, LFT, RFT, and PT were performed monthly to determine side effects and safety. To evaluate treatment efficacy, HCV RNA was measured by PCR at 12 weeks (end of treatment) and 12 weeks post-treatment (sustained virological response). Treatment lasted for 24weeks for those with compensated cirrhosis. (Child Turcotte Pugh score 5 and 6; Child class A) or those who were treatment experienced. SPSS 24 was used for data analysis. Results: Non cirrhotic patients had a mean age of 13.6±1.45 years, while those with compensated cirrhosis had 14.1±2.15 years. There were 63.6% males (28) and 36.4% female (17). 41 patients (91.11%) had undetectable HCV RNA by PCR ,12 weeks after treatment (Sustained virological response), indicating treatment effectiveness. Nine patients had HBV co-infection and took HBV medications as well during HCV treatment. At 12 weeks post-treatment, all HBV-coinfected patients had undetectable HCV RNA by PCR and lower HBV titers. Some of the patients experience minor side effects. However, none of the patients stopped their treatment due to these side effects Thus, this treatment was safe and effective. Conclusion: Sofosbuvir/ velpatasvir has effectiveness and safety in treating HCV in children and young adults.
Objective: To determine the association between serum CA-125 levels and degree of fibrosis in chronic liver disease with portal hypertension. Methodology: This study was conducted at Mayo Hospital Lahore. A total of 63 patients with liver cirrhosis were enrolled, demographic, clinical and laboratory parameters were documented. Modified FIB-4 index was calculated and value of 3 or more was defined as advanced liver cirrhosis. Receiver Operating Characteristic (ROC) curve was applied to calculate cut off value for CA-125 as 50 IU/L. Pearson correlation and linear regression analysis were applied to determine the association between CA-125 and modified fib -4 index. Results: Sixty three patients were enrolled. Mean age was 52.047±12.78. Female patients were 22(34.9%) and male patients were 41(65.1%). Regarding the clinical features, 8(12.7%) patients had jaundice, 38(60.3%) had ascites , 61(96.8%) had splenomegaly ,58(92.1%) had history of upper gastrointestinal bleed while 12(19%) had history of hepatic encephalopathy. Mean value of Modified fib-4score was 4.75±2.89SD, 43(67.2%) had value above cutoff of 3. Total of 38(60.3%) had CA-125 value above the cutoff level of 50 IU/L. CA-125 value above 50 IU/L has 63% sensitivity and 70% specificity in predicting advanced liver fibrosis and this association was statistically significant. (p value 0.024) . Conclusion: Serum CA-125 level above 50 IU/L is associated with presence of significant liver fibrosis.
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