Efficacy and safety of sofosbuvir plus ribavirin in treatment-naive chronic hepatitis c genotype 3 patients of South Punjab, Pakistan

Background: To evaluate the efficacy and safety of sofosbuvir (SOF) plus ribavirin (RIB) in naive patients with chronic HCV genotype 3. The study design was open label, quasi experimental study. The study was conducted at Medical Outpatient Department of Medical Unit-1, Bahawal Victoria Hospital, affiliated with Quaid e Azam Medical College (QAMC), Bahawalpur, from April 2016 to June 2019.Methods: A total of 627 treatment-naive patients, aged above 18 years, with chronic Hepatitis C virus (HCV) genotype 3 infection were enrolled. SOF as 400 mg once a day plus weight-based RIB (1000 mg/day 75 kg) was given to all the study participants for 24 weeks. Qualitative polymerase chain reaction (PCR) for HCV ribonucleic acid (RNA) were done at 4 weeks to note the rapid virological response (RVR) whereas end of treatment response (ETR) was recorded at 24 weeks and sustained virological response (SVR) was noted 3 months after completion of treatment.Results: By 4th week, PCR of 524 (83.6%) patients was available, out of which, 492 (93.9%) had undetectable HCV RNA. By the end of treatment (24 weeks), PCR of 401 (64.0%) patients was available, out of which, 393 (98.0%) had undetectable HCV RNA. Data of 291 (46.4%) patients was available for SVR, 274 (94.1%) had undetectable HCV RNA. Weakness and fatigue turned out to be the commonest side effects, observed in 236 (37.6%) patients.Conclusions: Sofosbuvir was found to have good efficacy and safety in the local population of South Punjab having treatment-naïve chronic HCV genotype 3 infection

Cleaning Methods for Ultrasound Probes

Objective: To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. Study Design: Experimental study. Place and Duration of Study: Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007. Patients and Methods: A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning ultrasound probe, which included sterilized paper towel, 0.9% saline and swipe over with standard bath soap applied on group A (n=25), group B (n=25) and group C (n=25) respectively. Number of Colony Forming Unit (CFU) of bacteria were calculated on standard agar plate to find out the effectiveness of cleaning methods in reducing bacterial count from the ultrasound probe after the procedures. All samples were tested in single microbiology lab by using same bacterial growth media provided by same manufacturer. Kruskall Wallis, Jonchkheere-Terpstra and Wilcoxon sign rank tests were applied to find out statistical significance. Results: There was a significant reduction in bacterial count after applying either of all three cleaning methods for ultrasound probe compared to count on the probes before cleaning (p Conclusion: Cleaning ultrasound probe after performing each procedure is a cost-effective practice with potential of reducing nosocomial infections. Soap cleaning technique is the most effective method for reducing bacterial count acquired due to patients’ body contact with the ultrasound probes

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

War for peace in Pakistan

Pakistan because of its geographical location became a front line state in the war against terror since the attack on the World Trade Centre on September 11, 2001. Pakistan decided to align with USA to combat the fundamentalist. It’s a war whose main purpose is to save people from terrorism but now lives of Pakistan own citizens are at stake. Innocent citizens have become the targets of deadly attacks. It has resulted in much more loss of lives than 9/11 attack. One obvious and tragic price of this open war is the toll of death and destruction. But there is an additional cost, a psychological cost borne by the survivors of war. The civilian population, and the children who have lost their parents in this war are the real casualties we need to take into consideration. This article will highlight the psycho-social aspects of war which could not achieve peace yet

2 in 1 (gender identity disorder)

A person with this disorder often experiences great discomfort regarding his or her actual anatomic gender. People with gender identity disorder may act and present themselves as members of the opposite sex and may express a desire to alter their bodies. The disorder affects an individual's self-image, and can impact the person's mannerisms and behavior. As gender identity develops in children, with sex-role assignment. Sex role-stereotypes are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by ones family and friends, the mass-media, and their community. Since many cultures strongly disapprove of cross-gender behavior, it often results in significant problems for affected persons and those in close relationships with them. In many cases, discomfort is also reported as stemming from the feeling that one's body is "wrong" or meant to be different. The need for treatment is emphasized by the high rate of mental health problems, including Depression with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates GENDER IDENTITY DISORDER is the case of a young man from Brunei Darussalam, who was seen and treated. This presentation will highlight the cultural and religious perspective of this Disorder

War for the peace in Pakistan

Pakistan because of its geographical location became a front line state in the war against terror since the attack on the World Trade Centre on September 11, 2001. Pakistan decided to align with USA to combat the so-called fundamentalist and Islamic terrorist. During last 5 years about 7000 people were killed and 10,000 were seriously injured. Currently, the biggest threat to the state and citizens is the killing of innocent civilians in suicidal and other attacks. It’s a war whose main purpose is to save people from terrorism. But now lives of Pakistan own citizens are at stake. Before 2001 there were very few citizens in Pakistan who knew about the suicide bombings but today there are very few who do not know about this. Innocent citizens have become the targets of these deadly bombs. It has resulted in much more loss of lives than 9/11 attack. Moreover, law and order situation in the country has constantly deteriorated since 2001. One obvious and tragic price of this open war is the toll of death and destruction. But there is an additional cost, a psychological cost borne by the survivors of war and socio-economic pressure. The civilian victims of war may suffer the greatest psychological harm, for they have not been prepared to manage the stress, shock, and fright of violence. The civilian population, who were drawn away from their safe surroundings and the children who have lost their parents in this war are the real casualties we need to take into consideration. There is need to create awareness on peace among researchers. I feel very much concerned for understanding and discussing these issues from various perspectives, including an Islamic perspective. This presentation will highlight the psycho-social aspects of war which could not achieve peace yet

Gender identity disorder is not simply two in one

A Case Report on Gender Identity Disorder with Recurrent Depressive Disorder is presented. Individuals having this disorder often exhibit discomfort about their actual anatomic gender, and they may have wished to alter their bodies. Sex role-stereotypes adopted during childhood are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by one's family and friends, the mass-media, and their community. Since some cultures disapprove of cross-gender behavior, it often results in significant problems for affected individuals and those in close relationships with them. The importance of treatment is not only because of the high rate of mental-health problems, including Depression but with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates Gender Identity Disorder is the case of a young man from Brunei Darussalam, who was seen and treated. This contribution will highlight the cultural and religious perspective of this Disorder