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Abstract

Background Chronic hepatitis C including liver cirrhosis poses challenges in treatment despite the availability of direct acting antivirals. AimTo compare clinical and patient reported outcomes of routinely used pharmacotherapy in Hepatitis C infection (with or without cirrhosis). MethodsA prospective cohort study was undertaken recruiting outpatients from a large referral tertiary care hospital. Patients who were diagnosed of having Hepatitis C Virus (HCV) infection and presented with or without cirrhosis were included. A standard 12 weeks treatment comprising Sofosbuvir (SOF) 400mg O.D/ Daclatasvir (DCV) 60mg O.D with and without Ribavirin (RBV) 400mg B.D or T.I.D was used. The cure rate in terms of end-of-treatment response at the end of 12 weeks treatment and patient reported outcomes (PROs) in terms of health related quality of life using EQ-5D-3L and work productivity loss were determined. Results The treatment regimen was found to be effective treatment in non-cirrhotic group in terms of cure rate compared to the cirrhotic patients (92.6 % vs 53%; p value<0.05). Cirrhotic patients showed significantly low score of PROs before initiating the treatment. After 12 weeks’ treatment, significantly higher rate of improvement was observed in non-cirrhotic patients’ PROs compared to cirrhotic group (p-value; <0.05). Conclusion DAAs showed higher effectiveness in clinical outcomes and patient reported outcome measures in chronic hepatitis C patients without cirrhosis compared to those with cirrhosis. It is imperative to develop and optimize further effective treatment options for cirrhotic CHC patients.

Tobacco use and related exposure in Pakistan are responsible for approximately 110,000 deaths. While previous studies have reported improved knowledge about the health risks of cigarette smoking among the general population due to ongoing tobacco control programs, fewer studies have investigated such knowledge in young adults. Thus, we conducted a comparative cross-sectional study of 220 young adult students aged 22 years (interquartile range (IQR) = 2) enrolled at a public university to assess their knowledge of the health risks of cigarette smoking and to compare this knowledge between smokers and nonsmokers. The self-administered semistructured questionnaire collected sociodemographic data, cigarette smoking status, and knowledge about the health risks of cigarette smoking. Data were analyzed using descriptive statistics, the chi-square test, and the Mann‒Whitney U test. Overall, most young adults were nonsmokers (69.09%), and the remaining 30.91% of smokers smoked an average of 5.31 ± 2.40 cigarettes daily for 3.80 ± 1.33 years, primarily in rural areas (p < 0.05). Nearly half of the young adults showed good knowledge of the health risks of cigarette smoking, irrespective of smoking status (smokers = 54.41%, nonsmokers = 53.29%). Conversely, few young adults demonstrated poor knowledge (smokers = 10.29%, nonsmokers = 6.58%) about the health hazards of cigarette smoking. Our findings showed that smoking rates were higher among young adults in rural settings than in urban areas. In addition, knowledge of gender-specific health risks associated with cigarette smoking, such as pregnancy-related complications in female smokers and male impotence in male smokers, was low. Nonetheless, almost half of the young adults displayed good knowledge of most of the potential health risks of cigarette smoking, regardless of their smoking status.