Usefulness of convalescent plasma transfusion for the treatment of severely ill COVID-19 patients in Pakistan.

BACKGROUND: Convalescent plasma(CP) was utilized as potential therapy during COVID-19 pandemic in Pakistan. The study aimed at appraisal of CP transfusion safety and usefulness in COVID pneumonia. METHODS: Single arm, MEURI study design of non-randomized open label trial was conducted in five centers. Patients werecategorized as moderately severe, severe, and critical. The primary endpoint was a) improvement in clinical status and change in category of disease severity; secondary endpoint was b) CP ability to halt disease progression to invasive ventilation. CP transfused to hospitalized patients. Statistical tests including median (interquartile ranges), Mann-Whitney U test, Fisher's exact test using SPSS ver. 23, ANOVA and Chi-square test were applied for the analysis of results parameters before and after CP treatment. SOFA score was applied for multiorgan failure in severe and critical cases. RESULTS: A total of 50 adult patients; median age 58.5 years (range: 29-92 years) received CP with infusion titers; median 1:320 U/mL (Interquartile range 1:80-1:320) between April 4 to May 5, 2020. The median time from onset of symptoms to enrollment in trial was 3 to 7 days with shortness of breath and lung infiltration as severity criterion. In 35 (70%) recipients, oxygen saturation improved from 80 to 95% within 72h, with resolution of lung infiltrates. Primary endpoint was achieved in 44 (88%) recipients whereas secondary endpoint was achieved in 42 (84%). No patient experienced severe adverse events. A high SOFA score (> 7) correlated with deaths in severe and critical patients. Eight (16%) patients expired due to comorbidities; cardiac arrest in 2 (4%), multiorgan failure secondary to cytokine storm in 5 (10%) and ventilator associated complications in 1 (2%). CONCLUSION: CP transfusion can be used as a safe and useful treatment in moderately severe and severe patients. TRIAL REGISTRATION: The trial registration number is NCT04352751  ( https://www.irct.ir/search/result?query=IRCT20200414047072N1 ). Trial Registration date is 28th April 2020.

The clinical and demographical profile of Coronavirus illness: The tale of Tablighi Jamaat and Zaireen in Quarantine / Isolation center at Sukkur and Hyderabad.

OBJECTIVES: To determine the clinical and demographical profile of corona-virus illness among Tablighi Jamaat and Zaireen kept in quarantine / isolation center at Sukkur and Hyderabad Sindh. METHODS: The cross-sectional descriptive study (late March-2020 to mid of April-2020) was conducted at Diagnostic & Research Laboratory LUMHS Jamshoro / Hyderabad. All the suspected cases for COVID-19 were recruited and screened for corona virus infection. The study explored the data of the suspected and diagnosed (confirmed) case of COVID-2019 (Tablighi Jamaat and Zaireen) reported by Diagnostic Research Laboratory Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro who belonged to various parts of the country in general and province Sindh in particular. All the individuals regardless of age and gender presented either as asymptomatic, critical ill or having non-specific symptoms as fever, flu, cough; sore throat and shortness of breath were screened for COVID-19 by real time PCR after taking informed consent whereas the frequency / percentages (%) and means ±SD computed for study variables. RESULTS: During study period total 920 patients were explored and screened for Corona virus infection. The mean ± SD for age (yrs) of overall population of city Sukkur and Hyderabad was 57.83±8.84 and 59.62±9.72 respectively. The 700 people from Sukkur city was screened and out of them 276 (39.4%) were positive and 424 (60.5) were negative while the cure rate was 245 (88.7%) along with mean ± SD for recovery time was 9.41±2.97. The 220 people from Hyderabad city was screened and out of them 106 (48.1%) were positive and 114 (51.8%) were negative while the cure rate was 106 (100%) along with mean ± SD for recovery time was 11.54±3.42. The majority of cases at both centers were asymptomatic (90%), symptomatic (7%) and critically ill (3%). The mortality accounted for 2.8% cases at Hyderabad isolation center and all were having smoking history and co-morbidities as ischemic heart diseases, diabetes mellitus, obstructive lung disease and cerebrovascular accident whereas no mortality was observed at Sukkur isolation center. CONCLUSION: RT-PCR measure allowed fast, delicate, and explicit discovery of SARS-CoV in biochemical diagnosis. The majority of cases at both centers were asymptomatic while the mortality was identified in 2.8% cases (having co-morbidities) at Hyderabad isolation center whereas no mortality was observed at Sukkur isolation center.

IL28B rs12980275 polymorphism shows association with response to treatment in Pakistani patients with chronic hepatitis C.

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.

Serum zinc level in patients with pneumonia: a six-month long cross-sectional descriptive study at Liaquat University Hospital Hyderabad, Sindh, Pakistan.

OBJECTIVE: To determine the serum zinc level in patients with pneumonia. METHODS: The descriptive cross-sectional study was conducted at the Liaquat University Hospital, Hyderabad, Pakistan, from September 2008 to February 2009. All patients above 12 years of age and of either gender who had been diagnosed with pneumonia were further evaluated for their serum zinc status.The data was analysed through SPSS 10.00, and p<0.05 was considered statistically significant. RESULT: The mean age of the 118 patients in the study was 25.64 +/- 6.53 years. The mean serum zinc level was 8.279 +/- 2.77 mmol/L, while the mean serum zinc levels in patients having low and normal levels was 6.740 +/- 1.47 mmol/L and 13.243 +/- 1.52 mmol/L respectively (p<0.001). The serum zinc was low in 42 of the 72 (58%) males, and 35 of the 46 (76%) females (p<0.04). There was also significant difference between mean serum zinc level in male and female patients (p<0.03). Out of 77 (65%) hypozincaemic patients, 69 (90%) recovered, while 08 (10%) failed to recover) during their hospital stay (p<0.33). Of the 69 who recovered, 29 (42%) patients did so in less than 2 weeks, while 40 (58%) patients recovered in more than 02 weeks. CONCLUSION: Serum zinc level was found to be low in patients with pneumonia.

Foetal outcome in patients with meconium stained liquor.

OBJECTIVE: To determine the foetal outcome and mode of delivery in patients with meconium stained liquor during labour. METHODS: The observational study was carried out at the Obstetrics and Gynaecology Unit-II of Liaquat University of Medical Health Sciences from June to November 2007. The patients with gestational age more than 37 weeks who presented with meconium stained liquor and cephalic presentation were included and the foetal outcome and mode of delivery was assessed in all such subjects. The data was collected on pre-designed proforma and analysed using SPSS version 10. Chi square test was applied with 95% confidence interval and p-value < or = 0.05 was considered significant. RESULTS: A total of 75 patients with meconium stained liquor were identified during the study period. The patients with reactive cardiotocography (CTG) were 50 (66.7%) and with non-reactive CTG, 25 (33.36%). Of the total, 45 (60%) patients were delivered through normal vaginal delivery, while 30 (40%) were delivered by caesarean section. The rate of instrumental delivery was also increased which was 12 (26.7%). Among the neonates exposed to meconium stained liquor, 62 (82.7%) babies were delivered with apgar score > 7. Only 13 (17.3%) babies were delivered with apgar score < 7 in one minute. CONCLUSION: Meconium stained amniotic fluid is a common occurrence during labour and is associated with increased caesarean section rate and foetal morbidity and mortality.

Possible Therapeutic Effects of Adjuvant Quercetin Supplementation Against Early-Stage COVID-19 Infection: A Prospective, Randomized, Controlled, and Open-Label Study.

BACKGROUND: Quercetin, a well-known naturally occurring polyphenol, has recently been shown by molecular docking, in vitro and in vivo studies to be a possible anti-COVID-19 candidate. Quercetin has strong antioxidant, anti-inflammatory, immunomodulatory, and antiviral properties, and it is characterized by a very high safety profile, exerted in animals and in humans. Like most other polyphenols, quercetin shows a very low rate of oral absorption and its clinical use is considered by most of modest utility. Quercetin in a delivery-food grade system with sunflower phospholipids (Quercetin Phytosome®, QP) increases its oral absorption up to 20-fold. METHODS: In the present prospective, randomized, controlled, and open-label study, a daily dose of 1000 mg of QP was investigated for 30 days in 152 COVID-19 outpatients to disclose its adjuvant effect in treating the early symptoms and in preventing the severe outcomes of the disease. RESULTS: The results revealed a reduction in frequency and length of hospitalization, in need of non-invasive oxygen therapy, in progression to intensive care units and in number of deaths. The results also confirmed the very high safety profile of quercetin and suggested possible anti-fatigue and pro-appetite properties. CONCLUSION: QP is a safe agent and in combination with standard care, when used in early stage of viral infection, could aid in improving the early symptoms and help in preventing the severity of COVID-19 disease. It is suggested that a double-blind, placebo-controlled study should be urgently carried out to confirm the results of our study.

Discoid lupus erythematosus: a profile.

OBJECTIVE: To determine the demographic data, clinical pattern and therapeutic outcome in patients with discoid lupus erythematosus (DLE). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Department of Dermatology, Liaquat University of Medical and Health Sciences, Jamshoro, from January 2004 to December 2008. METHODOLOGY: Patients of either gender aged above 18 years diagnosed with DLE were enrolled for the study. Those with evidence of systemic lupus erythematosus were excluded. Apart from the onset, duration, symptoms, lesion's location, size and dimensions were noted. Biopsy was taken when the diagnosis was in doubt. Apart from routine investigations serum anti-nuclear factor was determined in every patient. The data were analyzed using SPSS software version 11.0 for frequencies and percentages. RESULTS: There were 110 patients (38 males and 72 females), with ages between 18 and 62 years. Family history was positive in 3 patients. The plaque form was the most common clinical type seen in 68 (61.8%) patients, followed by tumid (n=20, 18.2%), panniculitis (n=10, 9.1%) and ulcerative (n=8,7.3%) types. Face was the most common site affected (n=60, 54.5%). Antinuclear antibody was present in 19 (17.3%) patients. Fatigue and joint pains were the commonest symptoms (n=52, 47%). Pigmentation and scarring were the usual outcome. CONCLUSION: DLE is a chronic disease with multiple presentations, which usually ends with pigmentation and scarring.

Oral lichen planus: a clinical study.

OBJECTIVE: To evaluate the clinical characteristics, predisposing/aggravating factors and malignant potential of oral lichen planus (OLP). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Dermatology and Oral Pathology, Liaquat University Hospital, Hyderabad, from January 2006 to November 2007. METHODOLOGY: Patients of either gender aged above 12 years, fulfilling the diagnostic criteria for OLP were enrolled for study. Patients not willing to participate or suspected to have drug-induced lichenoid reactions were excluded. History regarding the onset and duration, symptoms, addictions was elicited followed by oral, cutaneous and systemic examination. Biopsy was taken when the diagnosis was doubtful or malignancy was suspected. The data were analyzed using SPSS software version 11.0 for frequency and percentage. RESULTS: A total of 95 patients (40 male and 55 female), aged between 17 and 62 years were enrolled. Diabetes (n=05) and hypertension (n=04) were the accompanying comorbidities. Family history was positive in 3 patients only. Reticular form was the most common clinical type seen in 52 (54.7%), followed by erosive in 31 (32.6%) and atrophic/erythematous types in 12 (12.6%) patients. The disease caused pain, burning and other symptoms in 72 (75.7%) patients. Buccal mucosa was the chief site of involvement (n=31). Other sites involved were tongue (n=20), lips (n=28), palate (n=9) and floor of mouth (n=03). Stress, spicy foods and poor oral hygiene aggravated disease in most (n=77) of the patients. CONCLUSION: OLP is a chronic disease with diverse clinical manifestations and multiple site involvement. Associated pigmentation of surrounding mucosa was unique finding of this study. Long-term follow up is needed to assess the malignant potential. Stress was the most important factor aggravating the disease.

Frequency and pattern of gonorrhoea at Liaquat University Hospital, Hyderabad (a hospital based descriptive study).

OBJECTIVE: To determine the frequency and pattern of gonorrhoea at Liaquat University Hospital, Hyderabad. METHODS: This descriptive study of eight months was conducted at Liaquat University Hospital Hyderabad, Sindh, Pakistan from December 2007 to May 2008. All patients who were above 14 years of age and came with history of discharge from penis or vagina were evaluated and enrolled in the study. After recording demographic data these were screened for gonococcal infection by Gram's staining method. The frequency was determined by identifying the positive gonococcal infected patients while pattern was observed according to the presentation of patients. The data was analyzed by SPSS version 10.00. RESULT: One hundred and eighteen patients, 92 (78%) male and 26 (22%) females were identified to have infection out of 266 patients with mean age 27.4 +/- 7.77 years. Majority of the patients 92 (78%), presented in the department of dermatology. In the study group, 77 (65%) were unmarried and 41 (35%) were married, 71 (60%) belonged to Hyderabad and 47 (40%) came from periphery of Sindh province of Pakistan. Other features and presentation identified in such patients were painful micturition 98 (83%), burning micturition 94 (80%), frequent micturition 108 (92%), genital itching 85% (72%), intermenstrual bleeding 09 (8%), painful sexual intercourse 87 (74%) and skin lesions 24 (20%). All patients were treated by syndromic management. CONCLUSION: A relatively high prevalence of gonorrhoea (46% patients) was detected in the patients seen in Liaquat University Hospital.

Frequency of syphilis in female sex workers at red light area of Hyderabad, Pakistan.

OBJECTIVE: To determine the frequency of syphilis in female sex workers (FSWs) at red light area of Hyderabad. METHODS: This study was conducted on female sex workers at red light area of Hyderabad, Pakistan during 2003. All female subjects who were between 17-35 years of age were evaluated and enrolled in the study. All such subjects were screened. for Treponema pallidum infection/syphilis by Treponema Pallidum Haemagglutination assay (TPHA). The frequency was determined by identifying the positive Treponema pallidum infected patients. For getting results the data was saved and analyzed in SPSS version 10.00. RESULTS: Total fifty (50) female sex workers were studied; their mean age was 26.22 +/- 4.47 years. Syphilis was identified in 22 (44%) females with mean age of 22.68 +/-1.46 years while remaining 28 (56%) with mean age 29.00 +/- 4.06 years were free from syphilis (p < 0.001). CONCLUSION: The female sex workers are prone and at risk to acquire sexual transmitted infections (STI), therefore for control and preventive measures, screening programmes should be initialized.

Precipitating factors of hepatic encephalopathy at a tertiary care hospital Jamshoro, Hyderabad.

OBJECTIVE: To determine the precipitating factors of hepatic encephalopathy (HE) in patients with liver cirrhosis at Liaquat University Hospital Hyderabad/Jamshoro. METHODS: This hospital based descriptive study was conducted from April 2007 to September 2007. All the patients who were more than 12 years of age and were diagnosed as hepatic encephalopathy were studied. During this period, 87 patients of hepatic encephalopathy were admitted. All patients were carefully examined, relevant investigations were performed and data was collected through pre-designed proforma. RESULTS: Male patients were 65 (75%), above 40 years of age 58 (67%), belonging to interior/periphery of Sindh 54 (62%), in grade IV of hepatic encephalopathy 70 (80%) and Anti-HCV positive were 52 (60%). The most common precipitating factors detected were infection 58 (67%), constipation 43 (49%) and gastrointestinal bleeding 39 (45%). Out of 87 patients, 68 had increased total leucocytes count, 09 patients had hypokalaemia, 24 patients, hyponatraemia, 64 hypoalbuminaemia and 54 patients had a disturbed coagulation profile. Fifty nine patients recovered and were discharged while 20 patients expired. Majority of expired patients had Child-Pugh score 10-15 and were in grade IV of hepatic encephalopathy. CONCLUSION: The study concluded that there were different factors which play a key role in hepatic encephalopathy. In these factors, infection was the most common.

Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital.

BACKGROUND: Nosocomial infection is defined as an infection which develops 48 hours after hospital admission or within 48 hours after being discharged. The objectives were to assess the frequency of nosocomial infection in patients admitted to intensive care unit (ICU) and to determine the etiological factors in such patients. It was an Observational Study and conducted in Intensive Care Unit, Liaquat University Hospital Hyderabad Sindh Pakistan from January 2008 to November 2008. METHODS: All patients above 16 years of age admitted in the ICU for more than 48 hours and developed clinical evidence of infection that did not originate from patients' original diagnosis at the time of admission, were included in the study. Data was entered in a proforma and analyzed using SPSS version 10.0. RESULTS: During the study period, 97 out of 333 patients acquired nosocomial infection. The frequency of nosocomial infection was 29.13%. Respiratory tract infection was seen in 29 (30.1%), urinary tract infection in 38 (39.1%) and blood stream infection in 23 (23.7%) patients. Other infections we identified were skin, soft tissue, wound and gastrointestinal tract infections. CONCLUSION: Patients admitted in intensive care unit are at more risk of acquiring nosocomial infection from different sources. It is suggested that proper nursing care, sterilization and disinfection of instruments and equipment and careful handling of invasive procedures are the best tool to control these life threatening infections.

Trace elements in blood samples of smoker and nonsmoker active pulmonary tuberculosis patients from Jamshoro, Pakistan.

Pulmonary tuberculosis (PTB) is a serious public threat throughout the world. PTB and smoking have a strong correlation. Malnutrition, poverty, addiction, overcrowding, illiteracy, unemployment, and poor hygienic conditions are the collective aspects for the disease progress. Pakistan is the fifth among 22 high tuberculosis (TB) burden countries and the fourth regarding multidrug-resistant tuberculosis (MDR-TB). The aim of study was to determine the concentration of essential and toxic elements from blood samples of smoker and nonsmoker PTB patients by inductively coupled plasma mass spectrometry (ICP-MS) followed by microwave acid digestion and compared with control subjects (n = 30). Eighty PTB patients were selected from different hospitals with age ranging 20-70 years. It was interpreted that the mean age among males and females was found to be 35.6 ± 1.4 and 33.5 ± 1.2, respectively, and the male patients were highly affected in contrast to females. Essential elements such as Mn, Fe, Zn, and Se were statistically found to be lower while Ca, Co, and Cu were found to be higher compared to the control group (p = 0.00). However, toxic elements like Al, Cr, Ni, As, Cd, and Pb were statistically elevated in smokers than nonsmokers. Further research is needed to understand the degree of the impact of essential trace elements on treatment outcome (follow-up) followed by balanced healthy nutritional supplementation along with medical therapy, consequently improving the pulmonary tuberculosis outcome and survival as well.

Lipid profile in children with coronary artery disease in Sindh, Pakistan.

AIM: To evaluate lipid profile in children with coronary artery disease (CAD) in Hyderabad, Sindh, Pakistan. METHODS: The study included 100 children (6-15 years), of which 43 were children of young parents (one or both) with recognized CAD, while the other 57 were children with no evidence of CAD (controls). All were evaluated for fasting blood lipid profile. Blood samples were collected from patients with CAD and healthy controls and analysis of the levels of lipid profile were carried out using a kit method on Microlab 300. RESULTS: Children with CAD had significantly higher levels of total serum cholesterol and triglycerides and decreased levels of high density lipoprotein and low density lipoprotein compared to children in the control group. Systolic and diastolic blood pressures were significantly higher, without any significant difference. CONCLUSION: CAD risk factors are significant regarding abnormal lipid levels. Genetic tendency seems to be important in the development of CAD in children.

Efficacy of PEG-interferon based treatment in patients with hepatitis C refractory to previous conventional interferon-based treatment.

OBJECTIVE: To determine the efficacy of peg-interferon-based therapy in patients refractory to previous conventional interferon-based treatment and factors predicting sustained viral response (SVR). STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Medical Unit IV, Liaquat University Hospital, Jamshoro, from July 2009 to June 2011. METHODOLOGY: This study included consecutive patients of hepatitis C who were previously treated with conventional interferon-based treatment for 6 months but were either non-responders, relapsed or had virologic breakthrough and stage ≥ 2 with fibrosis on liver biopsy. All eligible patients were provided peg-interferon at the dosage of 180 µg weekly with ribavirin thrice a day for 6 months. Sustained Viral Response (SVR) was defined as absence of HCV RNA at 24th week after treatment. All data was processed on SPSS version 16. RESULTS: Out of 450 patients enrolled in the study, 192 were excluded from the study on the basis of minimal fibrosis (stage 0 and 1). Two hundred and fifty eight patients fulfilled the inclusion criteria and 247 completed the course of peg-interferon treatment. One hundred and sixty one (62.4%) were males and 97 (37.6%) were females. The mean age was 39.9 ± 6.1 years, haemoglobin was 11.49 ± 2.45 g/dl, platelet count was 127.2 ± 50.6 103/mm3, ALT was 99 ± 65 IU/L. SVR was achieved in 84 (32.6%). The strong association was found between SVR and the pattern of response (p = 0. 001), degree of fibrosis and early viral response (p = 0.001). CONCLUSION: Peg-interferon based treatment is an effective and safe treatment option for patients refractory to conventional interferon-based treatment.

Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study.

OBJECTIVE: To determine the frequency of Helicobacter pylori (H. pylori) infection in diabetic and non-diabetic patients and to compare the frequency of H. pylori infection in both groups. STUDY DESIGN: Case control. PLACE AND DURATION: Department of Medicine, Liaquat University Hospital from October 2007 to March 2008. MATERIALS AND METHODS: This hospital-based case-control study was conducted on 148 subjects and divided into two groups i.e. type 2 diabetics and non-diabetics; each group consisting of 74 patients. All diabetic patients of >/= 35 years of age, both gender and the known cases with history of dyspepsia, epigastric pain or bloating for more than a month were screened for Helicobacter pylori infection. The collected data of both groups was evaluated and separated for analysis. RESULTS: Majority of the patients were male with mean age +/- SD, 52.86 +/- 8.51. Among the diabetic group, HpSA was positive in 54/74 (73%), whereas in the non-diabetic group HpSA was positive in 38/74 (51.4%) cases. Fasting blood glucose was identified as low in 04 (5.40%) H. pylori infected - diabetic patients where as the blood glucose level of 07 (9.45%) known diabetic patients was raised despite the ongoing medication. CONCLUSION: Diabetic patients are more prone and at risk to acquire H. Pylori infection. Therefore proper monitoring of blood glucose level and screening for H. pylori infection are effective preventive measures for this life threatening infection.

Metabolic investigations in patients with hepatitis B and C.

AIM: To investigate the similarities and dissimilarities in patients with hepatitis B and hepatitis C, clinically and metabolically. METHODS: Fifty patients with hepatitis B virus and hepatitis C virus infection were included in this study, along with fifty healthy controls for comparison purposes. Intravenous blood (10 mL) samples from patients and healthy subjects were collected and made to clot before serum was separated and immediately levels of the enzymes, alkaline phosphatase (ALK), creatinine phosphokinase (CPK), lactate dehydrogenase (LDH), serum glutamate oxaloacetate transaminase (s-GOT) and serum glutamate pyruvate transaminase (s-GPT) were determined by a kit method. For total content of each metal the serum samples were analyzed using atomic absorption spectrophotometry. Levels of cholesterol, triglycerides, urea, creatinine and uric acid were determined using a kit method on Microlab 300. RESULTS: Serum magnesium and copper levels remained unchanged, whereas the concentration of zinc decreased and iron increased significantly in both groups of patients. Total antioxidant activity was significantly decreased in both hepatitis B and C. Among the enzymes analyzed, ALK, s-GPT, LDH and s-GOT were all significantly increased in both patients with hepatitis B and C whereas CPK was significantly decreased in patients with hepatitis B and remained unchanged in patients with hepatitis C. CONCLUSION: The information accumulated by this study will help provide a better understanding of involved metabolic processes in order to design appropriate therapeutic approaches for treating these patients, so they can recover and lead normal lives.