Effectiveness of cephalosporins in hydrolysis and inhibition of Staphylococcus aureus and Escherichia coli biofilms.

IMPORTANCE: Staphylococcus aureus and Escherichia coli contribute to global health challenges by forming biofilms, a key virulence element implicated in the pathogenesis of several infections. OBJECTIVE: The study examined the efficacy of various generations of cephalosporins against biofilms developed by pathogenic S. aureus and E. coli. METHODS: The development of biofilms by both bacteria was assessed using petri-plate and microplate methods. Biofilm hydrolysis and inhibition were tested using first to fourth generations of cephalosporins, and the effects were analyzed by crystal violet staining and phase contrast microscopy. RESULTS: Both bacterial strains exhibited well-developed biofilms in petri-plate and microplate assays. Cefradine (first generation) showed 76.78% hydrolysis of S. aureus biofilm, while significant hydrolysis (59.86%) of E. coli biofilm was observed by cefipime (fourth generation). Similarly, cefuroxime, cefadroxil, cefepime, and cefradine caused 78.8%, 71.63%, 70.63%, and 70.51% inhibition of the S. aureus biofilms, respectively. In the case of E. coli, maximum biofilm inhibition (66.47%) was again shown by cefepime. All generations of cephalosporins were more effective against S. aureus than E. coli, which was confirmed by phase contrast microscopy. CONCLUSIONS AND RELEVANCE: Cephalosporins exhibit dual capabilities of hydrolyzing and inhibiting S. aureus and E. coli biofilms. First-generation cephalosporins exhibited the highest inhibitory activity against S. aureus, while the third and fourth generations significantly inhibited E. coli biofilms. This study highlights the importance of tailored antibiotic strategies based on the biofilm characteristics of specific bacterial strains.

Molecular identification of different toxinogenic strains of Clostridium perfringens and histo-pathological observations of camels died of per-acute entero-toxaemia.

Enterotoxaemia is a severe disease caused by Clostridium perfringens and render high mortality and huge economic losses in livestock. However, scanty information and only few cases are reported about the presence and patho-physiology of enterotoxaemia in camels. The bacterium induces per-acute death in animals due to rapid production of different lethal toxins. The necropsy of camels (per-acute = 15, acute = 3) was conducted at 18 outbreaks of enterotoxaemia in camels in the desert area of Bahawalpur region. At necropsy, the serosal surfaces of visceral organs in the abdominal, peritoneal and thoracic cavities were found to have petechiation with severe congestion. Moreover, both the cut-sections of different visceral organs and the histo-pathological analysis revealed the pathological lesions in heart, lungs, kidneys, spleen, small and large intestines. Grossly, the kidneys were severely congested, hyperemic, swollen and softer in consistency. Under the microscope, different sections of kidneys indicated that the convulated and straight tubules were studded with erythrocytes. In the intestines, there were stunting fusion of crypts and villi. Similarly, various histo-pathological ailments were also observed in the heart, lungs and spleen. At blood agar, the collected samples showed beta hemolytic colonies of C. perfringens that appeared as medium sized rods microscopically and stained positively on Gram staining. Multiplex PCR revealed C. perfringens type A (α and ß2 genes) and D (epsilon gene) and the deaths were found to be significantly higher due to C. perfringens type D compared to those by C. perfringens type A. Hence, it has been concluded that enterotoxaemia in camel affects multiple organs and becomes fatal, if occurred due to C. perfringens type D.

Global scenario of genetic diversity in cox1 and nad1 genes of Moniezia expansa.

Monieziasis is a parasite-borne production-limiting disease of livestock. Moniezia expansa is the most important species having cosmopolitan distribution. Despite of numerous prevalence reports, very little information is available about the evolutionary biology and population genetics of M. expansa. To close this research gap, this study was undertaken to recognize and inspect the genetic variation of M. expansa populations around the world using the cox1 and nad1 genes and deduce phylogenetic relationships with M. expansa populations. The cox1 and nad1 gene sequences were downloaded from the NCBI GenBank database. Followed by sequence alignment, median-joining networks were constructed using PopArt software. Diversity and neutrality indices were computed through DnaSp software while MEGA software was used to draw the maximum-likelihood phylogenetic tree. Thirty-two cox1 sequences, from five different countries, and 9 nad1 sequences from three different countries, were among the sequences used in this study. The cox1 and nad1 gene sequences had mutations in 97 and 36 different places, respectively. Twenty and 7 unique haplotypes were discovered for the cox1 and nad1 gene sequences, respectively. Comparable haplotype diversities were observed for both the genes under study (cox1 = 0.950; nad1 = 0.944). Negative Tajima's D and Fu Fs were found for the cox1 gene while these indices were positive for the nad1 gene. Phylogenetic analysis also showed the existence of unique haplotypes for both the cox1 and nad1 genes. The results of this study indicate that there is the existence of a huge genetic diversity in M. expansa isolates. For future studies, it is recommended that longer gene sequences should be used to describe genetic variation among M. expansa isolates as the length of the gene under study affects the genetic variation. Moreover, additional mitochondrial markers should also be investigated because the assertive strength of a group of gene targets is superior to defining genetic diversity.

Current clinical practice of orofacial contracture management in head and neck burn patients among physical therapists of Hyderabad.

OBJECTIVE: To evaluate the current clinical practices of orofacial contracture management among physical therapists dealing with head and neck burn patients. Method: The cross-sectional observational study was conducted at the Isra Institute of Rehabilitation Sciences, Hyderabad, Pakistan, from May 14 to December 31, 2021, and comprised physical therapists working in different hospitals and clinics and having clinical experience >1 year. Data was collected using a questionnaire based on literature which included questions related to demographics, service provision, clinical training, orofacial burn wound assessment, orofacial contracture intervention and outcome measurement in multiple choice, dichotomous or open response formats. Data was analysed using SPSS 22. RESULTS: Of the 100 subjects, 38(38%) were males and 62(62%) were females, while 71(71%) were aged 20-30 years, 22(22%) were aged 31-40 years, and 7(7%) were aged 41-50 years. Besides, 57(57%) physical therapists used stretching/exercise in the management of superficial-partial thickness burn, while 49(49%) used it in deep-partial thickness burn, and 44(44%) in full-thickness burn. Also, 43(43%) therapists used presence or maturation of the scar tissue as the indicator to escalate/reduce the intensity of the treatment. Regarding splinting, 49(49%) therapists used it on the 5th day of grafting and 35(35%) used it after complete healing. CONCLUSIONS: There was minimal knowledge regarding the use of specific interventions and specific regimes at particular stages.

Seroprevalence and Molecular Evidence of Coxiella burnetii in Dromedary Camels of Pakistan.

Coxiellosis is a zoonosis in animals caused by Coxiella burnetii. A cross-sectional study was conducted on 920 (591 female and 329 male) randomly selected camels (Camelus dromedarius) of different age groups from 13 districts representative of the three different ecological zones in the Province Punjab, Pakistan to determine the prevalence and associated risk factors of coxiellosis. The blood samples were collected and tested for anti-C. burnetti antibodies using indirect multispecies ELISA. Real-time PCR was used for the detection of C. burnetii DNA to determine the prevalence in heparinized blood pools. Out of 920 investigated camels, anti-C. burnetii antibodies were detected in 288 samples (31.3%) (95% CI: 28.3-34.4%). The highest (78.6%) and lowest (1.8%) seroprevalence were detected in Rahimyar Khan (southern Punjab) and in Jhang (central Punjab), respectively. Potential risk factors associated with seropositivity of the Q fever in camels included desert area (42.5%; OR = 2.78, 95% CI 1.12-3.21) summer season (35.7%; OR = 2.3, 95% CI: 1.31-3.2), sex (female) (39.1; OR = 2.35, 95% CI: 1.34-2.98), tick infestation (51.3%;OR = 2.81, 95% CI: 1.34-3.02), age (>10 years; 46.4%; OR = 1.56, 95% CI: 0.33-2.05) and herd size (38.5%; OR = 1.21, 95% CI: 0.76-1.54). Coxiella burnetii DNA was amplified in 12 (20%) and 1 (10%) of 60 ELISA-negative and 10 suspected camels, respectively. DNA could not be detected in ELISA positive blood pools. This study emphasizes the seroprevalence and associated risk factors of coxiellosis as well as its potential to spill over to animals and humans in contact with these camel herds.

F-box only protein 9 and its role in cancer.

The F-box proteins (FBP), substrate recognition subunit of the SCF (Skp1-Cullin1-F-box protein complex) E3 ligase, play important roles in the ubiquitylation and subsequent degradation of the target proteins from several cellular processes. Disorders of F-box protein-mediated proteolysis lead to human malignancies. FBP plays an important role in many cellular processes, including cell proliferation, cell cycle, apoptosis, migration, invasion, and metastasis, suggesting that it can be associated with tumorigenesis, cancer development and progression. However, the expression and function of FBXO9 (F-box only protein 9) differ in various types of human cancer. Due to the ability to regulate the stability and activity of oncogenes and tumor-suppressor genes, and the physiological functions of many of the F-box proteins remain subtle, further genetic and mechanistic studies will elaborate and help define FBXO9's role. Targeting F-box protein or F-box protein signaling pathways could be an effective strategy for preventing or treating human cancer. This review is presented to summarize the part of FBXO9 in different types of human cancer and its regulation mechanism, and to pave the way to design FBXO9-targeting anticancer therapies.

Metabesity: expert panel recommendation for taking up the challenge by a multidisciplinary approach.

Metabesity refers to metabolic aberrations associated with obesity. These include low- grade inflammation, mitochondrial dysfunction, and changes in gut microbiome. Along with a genetic component, the phenotypes in metabesity are largely the result of sedentary lifestyle and unhealthy eating habits. Metabesity is associated with several co-morbidities including an increased risk for cardiovascular conditions like hypertension, heart failure, myocardial infarction, stroke, and sudden death. Insulin resistance, high blood pressure and glucose levels, visceral adiposity, progressive atherosclerosis, dyslipidaemia and fatty liver are common in obese individuals. Obesity increases the risk for and overall mortality due to cancer. Metabesity adversely impacts endocrine balances in the body and increases the risk of degenerative conditions like dementia. Metabesity is an impending epidemic of huge public health implications with enormous clinical, socioeconomic, and humanistic burden. Interventions to combat sedentary lifestyle and unhealthy eating should be introduced early in life to prevent the onset and progression of metabesity. This review also summarizes the experts' recommendation from Pakistan to manage the rising metabesity concern in their geography based on the literature evidences.

On computing critical factors based healthy behavior index for behavior assessment.

OBJECTIVE: Ubiquitous computing has supported personalized health through a vast variety of wellness and healthcare self-quantification applications over the last decade. These applications provide insights for daily life activities but unable to portray the comprehensive impact of personal habits on human health. Therefore, in order to facilitate the individuals, we have correlated the lifestyle habits in an appropriate proportion to determine the overall impact of influenced behavior on the well-being of humans. MATERIALS AND METHODS: To study the combined impact of personal behaviors, we have proposed a methodology to derive the comprehensive Healthy Behavior Index (HBI) consisting of two major processes: (1) Behaviors' Weight-age Identification (BWI), and (2) Healthy Behavior Quantification and Index (HBQI) modeling. The BWI process identifies the high ranked contributing behaviors through life-expectancy based weight-age, whereas HBQI derives a mathematical model based on quantification and indexing of behavior using wellness guidelines. RESULTS: The contributing behaviors are identified through text mining technique and verified by seven experts with a Kappa agreement level of 0.379. A real-world user-centric statistical evaluation is applied through User Experience Questionnaire (UEQ) method to evaluate the impact of HBI service. This HBI service is developed for the Mining Minds, a wellness management application. This study involves 103 registered participants (curious about the chronic disease) for a Korean wellness management organization. They used the HBI service over 12 weeks, the results for which were evaluated through UEQ and user feedback. The service reliability for the Cronbach's alpha coefficient greater than 0.7 was achieved using HBI service whereas the stimulation coefficient of the value 0.86 revealed significant effect. We observed an overall novelty of the value 0.88 showing the potential interest of participants. CONCLUSIONS: The comprehensive HBI has demonstrated positive user experience concerning the stimulation for adapting the healthy behaviors. The HBI service is designed independently to work as a service, so any other wellness management service-enabled platform can consume it to evaluate the healthy behavior index of the person for recommendation generation, behavior indication, and behavior adaptation.

Semantic preservation of standardized healthcare documents in big data.

BACKGROUND: Standardized healthcare documents have a high adoption rate in today's hospital setup. This brings several challenges as processing the documents on a large scale takes a toll on the infrastructure. The complexity of these documents compounds the issue of handling them which is why applying big data techniques is necessary. The nature of big data techniques can trigger accuracy/semantic loss in health documents when they are partitioned for processing. This semantic loss is critical with respect to clinical use as well as insurance, or medical education. METHODS: In this paper we propose a novel technique to avoid any semantic loss that happens during the conventional partitioning of healthcare documents in big data through a constraint model based on the conformance of clinical document standard and user based use cases. We used clinical document architecture (CDAR) datasets on Hadoop Distributed File System (HDFS) through uniquely configured setup. We identified the affected documents with respect to semantic loss after partitioning and separated them into two sets: conflict free documents and conflicted documents. The resolution for conflicted documents was done based on different resolution strategies that were mapped according to CDAR specification. The first part of the technique is focused in identifying the type of conflict in the blocks that arises after partitioning. The second part focuses on the resolution mapping of the conflicts based on the constraints applied depending on the validation and user scenario. RESULTS: We used a publicly available dataset of CDAR documents, identified all conflicted documents and resolved all the them successfully to avoid any semantic loss. In our experiment we tested up to 87,000 CDAR documents and successfully identified the conflicts and resolved the semantic issues. CONCLUSION: We have presented a novel study that focuses on the semantics of big data which did not compromise the performance and resolved the semantic issues risen during the processing of clinical documents.

On Curating Multimodal Sensory Data for Health and Wellness Platforms.

In recent years, the focus of healthcare and wellness technologies has shown a significant shift towards personal vital signs devices. The technology has evolved from smartphone-based wellness applications to fitness bands and smartwatches. The novelty of these devices is the accumulation of activity data as their users go about their daily life routine. However, these implementations are device specific and lack the ability to incorporate multimodal data sources. Data accumulated in their usage does not offer rich contextual information that is adequate for providing a holistic view of a user's lifelog. As a result, making decisions and generating recommendations based on this data are single dimensional. In this paper, we present our Data Curation Framework (DCF) which is device independent and accumulates a user's sensory data from multimodal data sources in real time. DCF curates the context of this accumulated data over the user's lifelog. DCF provides rule-based anomaly detection over this context-rich lifelog in real time. To provide computation and persistence over the large volume of sensory data, DCF utilizes the distributed and ubiquitous environment of the cloud platform. DCF has been evaluated for its performance, correctness, ability to detect complex anomalies, and management support for a large volume of sensory data.

MRPack: Multi-Algorithm Execution Using Compute-Intensive Approach in MapReduce.

Large quantities of data have been generated from multiple sources at exponential rates in the last few years. These data are generated at high velocity as real time and streaming data in variety of formats. These characteristics give rise to challenges in its modeling, computation, and processing. Hadoop MapReduce (MR) is a well known data-intensive distributed processing framework using the distributed file system (DFS) for Big Data. Current implementations of MR only support execution of a single algorithm in the entire Hadoop cluster. In this paper, we propose MapReducePack (MRPack), a variation of MR that supports execution of a set of related algorithms in a single MR job. We exploit the computational capability of a cluster by increasing the compute-intensiveness of MapReduce while maintaining its data-intensive approach. It uses the available computing resources by dynamically managing the task assignment and intermediate data. Intermediate data from multiple algorithms are managed using multi-key and skew mitigation strategies. The performance study of the proposed system shows that it is time, I/O, and memory efficient compared to the default MapReduce. The proposed approach reduces the execution time by 200% with an approximate 50% decrease in I/O cost. Complexity and qualitative results analysis shows significant performance improvement.

GUDM: Automatic Generation of Unified Datasets for Learning and Reasoning in Healthcare.

A wide array of biomedical data are generated and made available to healthcare experts. However, due to the diverse nature of data, it is difficult to predict outcomes from it. It is therefore necessary to combine these diverse data sources into a single unified dataset. This paper proposes a global unified data model (GUDM) to provide a global unified data structure for all data sources and generate a unified dataset by a "data modeler" tool. The proposed tool implements user-centric priority based approach which can easily resolve the problems of unified data modeling and overlapping attributes across multiple datasets. The tool is illustrated using sample diabetes mellitus data. The diverse data sources to generate the unified dataset for diabetes mellitus include clinical trial information, a social media interaction dataset and physical activity data collected using different sensors. To realize the significance of the unified dataset, we adopted a well-known rough set theory based rules creation process to create rules from the unified dataset. The evaluation of the tool on six different sets of locally created diverse datasets shows that the tool, on average, reduces 94.1% time efforts of the experts and knowledge engineer while creating unified datasets.

Behavior life style analysis for mobile sensory data in cloud computing through MapReduce.

Cloud computing has revolutionized healthcare in today's world as it can be seamlessly integrated into a mobile application and sensor devices. The sensory data is then transferred from these devices to the public and private clouds. In this paper, a hybrid and distributed environment is built which is capable of collecting data from the mobile phone application and store it in the cloud. We developed an activity recognition application and transfer the data to the cloud for further processing. Big data technology Hadoop MapReduce is employed to analyze the data and create user timeline of user's activities. These activities are visualized to find useful health analytics and trends. In this paper a big data solution is proposed to analyze the sensory data and give insights into user behavior and lifestyle trends.

Minimal invasive plate osteosynthesis of close fractures of distal tibia.

BACKGROUND: The limited soft tissue, subcutaneous location and poor vascularity render the tibial fractures very challenging. Treatment of distal tibial fractures using minimally invasive plate osteosynthesis (MIPO) technique may minimise damage to soft tissues and the vascular integrity of bony fragments, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. This descriptive study was conducted to assess the outcome of patients treated with MIPO technique for distal tibial fractures. METHODS: Seventy three cases of multifragmentary fractures of the distal tibia admitted in Bahawal Victoria Hospitals, Bahawalpur between April 2009 and October 2010 were included in this study. Patient's outcome in terms of period of radiologic union of the fractured segments and period of full weight bearing capacity were accessed. RESULTS: There were 66 males and 7 females of mean age 43 years. The mean follow-up period was 13 weeks. (Ranging from 9-16 weeks). All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks) showing radiological union. There were two superficial infections treated successfully using oral antibiotics and no failures of fixation. There were no cases of rotational malalignment. CONCLUSION: MIPO is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incisions is technically demanding but decreases surgical trauma to soft tissues.

Effect of HCV infection on hepatic fibrosis in patients of thalassaemia major.

OBJECTIVE: To investigate the effect of HCV infection on hepatic fibrosis in patients of thalassaemia major with iron overload in order to modify Pesaro criteria for classification into prognostic groups for allogenic haemopoietic stem cell transplant in these patients. DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Pathology, Armed Forces Bone Marrow Transplant Center and Departments of Pediatrics of Military Hospital and Combined Military Hospital, Rawalpindi, from July 2003 to June 2004. SUBJECTS AND METHODS: Twenty-eight HCV- and 18 HCV+ patients of thalassaemia major, who were prospective recipients of allogeneic bone marrow transplant, were included in the study. Serum ferritin was estimated by chemiluminescent immunoassay. Degree of fibrosis in liver biopsy was scored using Knodell s scoring system. Correlation between the two was evaluated statistically through Pearson s correlation coefficient. RESULTS: Mean serum ferritin was lower and degree of hepatic fibrosis was less in hepatitis C negative patients of TM. The correlation between serum ferritin and the degree of hepatic fibrosis was much stronger in hepatitis C negative patients with r value of 0.507 and p value of 0.006, which was statistically significant. CONCLUSION: A strong correlation between serum ferritin and degree of hepatic fibrosis was observed in patients of thalassaemia major not infected with hepatitis C infection. Serum ferritin levels alone are, therefore, not sufficient to assess degree of fibrosis in HCV positive patients of TM.

Estimation of ionized calcium, total calcium and albumin corrected calcium for the diagnosis of hypercalcaemia of malignancy.

OBJECTIVE: To measure levels of ionized calcium, total calcium and albumin corrected calcium in patients with different malignant disorders for the diagnosis of hypercalcaemia of malignancy. DESIGN: A case control comparative study. PLACE AND DURATION OF STUDY: The study was carried out in the Department of Pathology, Army Medical College Rawalpindi, Armed Forces Institute of Pathology and Department of Oncology CMH, Rawalpindi from March 2003 to December 2003. SUBJECTS AND METHODS: Ninetyseven patients of various malignant disorders, admitted in the Department of Oncology, CMH, Rawalpindi, and 39 age and gender-matched disease-free persons (as control) were included in the study. Blood ionized calcium (Ca++), pH, sodium (Na+) and potassium (K+) were analysed by Ion selective electrode (ISE) on Easylyte auto analyser. Other related parameters were measured by colourimetric methods. RESULTS: Blood Ca(++) levels in patients suffering from malignant disorders were found significantly high (mean +/- SD: 1.30+017 mmol/L) as compared to control subjects (mean +/- SD 1.23+0.03 mmol/L) (p<0.001). The number of patients with hypercalcaemia of malignancy detected by Ca(++) estimation was significantly higher (38%) as compared to total calcium (8.4%) and albumin corrected calcium ACC (10.6%) (p<0.001). There was no statistically significant difference in other parameters e.g. phosphate, urea, creatinine, pH, Na+ and K+ levels in study subjects and controls. CONCLUSION: Detection of hypercalcaemia can be markedly improved if ionized calcium estimation is used in patients with malignant disorders.

Efficacy and adverse effects of oral iron chelator deferiprone (l1, 1,2- dimethyl-3-hydroxypyrid-4-one) in patients with beta thalassaemia major in Pakistan.

BACKGROUND: Deferiprone (DFP,L1) is a bidentate oral iron chelator which binds to iron in a 3:1 ratio. It has the potential advantage of reduced cost and increased compliance. We conducted a study in order to determine the efficacy and adverse effects of DFP in Pakistani thalassaemic patients. METHODS: A group of 26 thalassaemic patients entered the study during the period Jan 1999 to Aug 2002. DFP supplied by Lipomed, Switzerland was given at a daily dose of 75 mg/kg/day (range 50-75 mg/kg/day). After giving informed written consent all the patients were subjected to clinical examination and investigations for monitoring the response. Blood complete picture, liver function tests, blood urea & creatinine, antinuclear factor antibodies (ANF) were tested in all cases before starting DFP treatment. RESULTS: The patients ages ranged from 11 to 27 years, 16 were male and 10 were female. Initial serum ferritin level ranged from 3100-8800 microg/l, mean serum ferritin level was 7129 +/- 1467 microg/l (95% CI 6536 - 7721 microg/l). ECG and Echocardiography was performed in all cases and in 11 cases Cardiac Multigated acquisition (MUGA) Scan was also performed and six patients with impaired left ventricular function were identified. Four patients were lost to follow up and one patient died due to cardiomyopathy. Among the remaining 21 patients serum ferritin levels dropped to 1900 microg/l to 5600 microg/l with mean level of 4288 microg/l (95%CI 3874 - 4702 microg/l), SD 911 microg/l. Significance of difference was (p < 0.001) by Paired samples 't' test. Six patients had gastrointestinal symptoms along with two having arthropathy. ANF positivity was not detected in any patient while on DFP treatment. Similarly, agranulocytosis was not detected in any patient. CONCLUSION: Mean serum ferritin level estimated at the start of trial was 7129 microg/l. This shows that Pakistani thalassaemic patients are quite iron overloaded due to socioeconomic reasons that are peculiar to our setup. In this study DFP was well tolerated and caused fewer side effects. It had much better patient compliance and was effective in lowering serum ferritin level in previously most poorly chelated patients.

Treatment response in HCV related chronic hepatitis.

OBJECTIVE: To evaluate the virological response to treatment with interferon and ribavirin in patients with hepatitis C related liver disease. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: January to September 2002 at Virology Department, Armed Forces Institute of Pathology Rawalpindi. MATERIAL AND METHODS: Two hundred seventy-nine patients were included in the study. These patients had taken interferon and ribavirin treatment for HCV related chronic hepatitis, and were referred to AFIP for HCV RNA testing by polymerase chain reaction (PCR) between January 2002 and September 2002. Out of 279 cases, 229 had taken the treatment for 06 or 12 months and were tested for end-of-treatment response (ETR). Fifty patients had completed their treatment regimens of 6 or 12 months treatment, at least 24 weeks before their PCR test and were having follow-up testing for sustained viral response (SVR). The sera of these patients were tested for HCV RNA by PCR, using a commercial kit of Amplicor (Roche) for qualitative detection of HCV RNA. RESULTS: Out of 229 cases tested for end-of-treatment response, 198 (86.5%) had no detectable HCV RNA (responders) and 31(13.5%) were PCR positive (non-responders). Thirty-eight out of 50 cases, tested for a sustained viral response, had a negative result for HCV PCR thus showing sustained response rate of 76%. CONCLUSION: The viral remission/response to interferon and ribavirin combination therapy in our patients was better than that quoted in other regions.