Recent studies have indicated that cytokines can be used as markers for disease progression in hepatitis C virus (HCV)-infected patients, therefore this study was conducted to determine the influence of pegylated IFN vs standard IFN on interleukin-2 receptor (IL-2R), IL-6R, IL-8, TNFR-I, TNFR-II, sFas, and sFas-L in Egyptian patients with chronic hepatitis C genotype 4, as no previous studies have been performed on this genotype. We also aim at establishing a possible relationship between these cytokines and the response to INF to determine whether they can be used as noninvasive markers for the response to INF therapy and as monitors for the outcome of treatment. Thirty-eight patients with chronic HCV hepatitis were investigated for the serum levels of the previously mentioned cytokines in a randomized opened controlled trial (22 patients treated with pegylated IFN and 16 patients treated with standard IFN). Cytokine levels were measured by ELISA at 0, 1 and 12 months of IFN therapy. There was marked increase in the serum levels of IL-2R and IL-6R in nonresponders to pegylated interferon, IL-8, TNFR-I and II were significantly higher in nonresponders to standard interferon but were also high in responders of pegylated interferon. sFas and sFas-L showed high levels among responders to pegylated interferon but the standard interferon was again less effective in this regard. Serum levels of TNFR-II, sFas and sFas-L have the potential to be used as serological markers for response to pegylated IFN therapy, and IL-8 is a predictor for nonresponse. Moreover, TNFR-I and II have the potential to be used as markers of response to standard IFN treatment. The persistent correlation between sFas and TNFR-II may elaborate the possible role of pegylated IFN in the induction of apoptosis as a possible new mechanism of viral clearance during treatment with pegylated interferon treatment.
Introduction: Hepatic encephalopathy is a common complication of cirrhosis.Its development heralds a poor prognosis. Hepatic encephalopathy is often precipitated by an identifiable factor. Promptdiagnosis of precipitating factors is the key to management of this reversible complication of cirrhosis. Objective: Todetermine the frequency of precipitating factors for hepatic encephalopathy in patients diagnosed with cirrhosis. StudyDesign: Descriptive Study. Place and Duration of study: The study was carried out at Combined Military HospitalLahore from 18.6.07 to 18.12.2007. Patients and methods: Eighty Consecutive patients, 18 years and above of bothgenders suffering from hepatic encephalopathy were included in the study. Precipitating factors of hepaticencephalopathy were identified with the help of clinical examination and investigations. Results: Majority of patients(63.8%) had one precipitating factor; more than one factorwas found in 27.5%. Upper gastrointestinal bleed (56%) andinfections (27%) (spontaneous bacterial peritonitis and urinary tract infections) were the leading precipitating factors.Use of diuretics/ electrolyte imbalance and constipation were found in 19% and 7% of patients respectively. Noprecipitating factor was detected in 9% of patients. Conclusion: In majority of patients with hepatic encephalopathy,precipitating factor/ factors could be easily identified.
Objective: Blind Nasotracheal Intubation (BNI) can be undertaken aftermuscle relaxation with Inj. Succinylcholine or under deep inhalational anesthesia. The objective of study was todetermine the preferred one of these 2 techniques of BNI. Design: Prospective, randomized study. Place andDuration of Study: PNS SHIFA, Karachi and AFID, Rawalpindi from May 2002 to April 2005. Subjects and Methods:Sixty patients between 10 - 40 years of age presenting for elective surgery in whom BNI was required due to limitedor no mouth opening were enrolled through convenient sampling. Patients were randomly divided into two groups:WMR (n=30) or NMR (n=30) to undergo BNI after relaxation with Succinylcholine or under inhalational anesthesia with2% Halothane, respectively. A red rubber nasal endotracheal tube (cuffed and un cuffed in adults and childrenrespectively) was used. Results: The frequency of successful BNI in WMR group was 100% and significantly higher(P=0.03) than in the NMR group (86%). Time to succeed was significantly less in the WMR group 2±0.9 minutes versus3.4±2.0 in the NMR group. There was no statistically significant difference of occurrence of adverse events in the twogroups. Conclusion: BNI with Succinylcholine produced a higher success rate. This technique can decrease failureto intubate, we speculate that it may, therefore, increase patient safety.
Objectives: To determine the frequency of hepatotoxicity with standard ATT. Study design: Descriptive. Setting: Department of Medicine, Combined Military Hospital Lahore. Period: Feb 2007 to April 2008. Materials & methods: 250 patients aged 18 years or greater having pulmonary TB were selected through non-probability convenience sampling technique. All patients were given four drugs for two monthsindoors, followed by two drugs for four months in outdoor. Symptoms suggestive of hepatotoxicity were enquired from the patients regularly. Serum bilirubin and ALT were measured on monthly basis and finally on completion of therapy. Hepatotoxicity was defined as a five fold rise in serum ALT. In patients developing hepatotoxicity, treatment was modified accordingly. Results: This study was done on 189 male and 61female patients (total: 250). Hepatotoxicity developed in 13 (5.2%) patients, mostly during the initial phase of treatment (84.6% incidence during the first month). Risk factors included: age (4 out of 156 young patients and 9 out of 94 older patients; p: 0.016) and nutritional status (8 malnourished patients and 5 well nourished patients; p: 0.031). Hepatotoxicity was not related to the gender (9 males and 4 females; p: 0.585) orthe results of baseline sputum smears (7 out of 102 smear positive cases and six out of 148 smear negative cases; p: 0.064). Conclusions: Hepatotoxicity with ATT is fairly common, especially in the elderly, malnourished patients and during the initial phase of treatment.
Objectives: To determine the frequency of thrombocytopenia and its manifestations in patients with Chronic Hepatitis C Virusinfection treated with interferon and ribavirin. Data Source: In door and out door patients. Design of Study: Case series. Setting and Periodof Study: Department of Medicine PNS Shifa Hospital Karachi, from 1s t August 2006 to 1s t July 2007. Materials and Methods: A Proformawas designed to enter the data of 100 patients fulfilling the inclusion criteria included in the study. Adult patients between the ages of 18 and50 years of both gender were selected. Presence of anti HCV antibodies, elevated serum alanine transaminase, a positive polymerase chainreaction for hepatitis C ribonucleic acid and compensated liver disease were prerequisites. All patients were treated with combination ofinterferon and ribavirin. Blood counts, alanine transaminase and prothrombin time were done at baseline and at 2,4 & 8 weeks intervals afterstarting interferon. A drop in platelets count below 100,000/cmm was taken as interferon induced thrombocytopenia. Results: In our studythrombocytopenia occurred in 11 % patients. Grade 3 thrombocytopenia (platelet counts < 50,000) occurred in 01 patient out of hundred in whichthere was severe gum bleeding and purpura so antiviral treatment was discontinued. Grade 2 thrombocytopenia (platelet counts between 50,000- 75,000) was observed in 03% patients but there were no bleeding episodes, 50% reduction dose was done in these patients. Grade 1thrombocytopenia (platelet counts between 75,000-100,000) was noticed in 07% patients but there were no bleeding manifestations and dosereduction was not done. Conclusion: Combination therapy is well tolerated, however, it can cause life threatening complications like bleedingepisodes in a few patients. Bleeding complications and manifestations as a result of thrombocytopenia are uncommon.
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