Exploring measurement tools to optimise hospital physician distribution.

INTRODUCTION: Equitable healthcare delivery is essential and requires resources to be distributed, which include assets and healthcare workers. To date, there is no gold standard for measuring the correct number of physicians to meet healthcare needs. This rapid review aims to explore measurement tools employed to optimise the distribution of hospital physicians, with a focus on ensuring fair resource allocation for equitable healthcare delivery. MATERIALS AND METHODS: A literature search was performed across PubMed, EMBASE, Emerald Insight and grey literature sources. The key terms used in the search include 'distribution', 'method', and 'physician', focusing on research articles published in English from 2002 to 2022 that described methods or tools to measure hospital-based physicians' distribution. Relevant articles were selected through a two-level screening process and critically appraised. The primary outcome is the measurement tools used to assess the distribution of hospital-based physicians. Study characteristics, tool advantages and limitations were also extracted. The extracted data were synthesised narratively. RESULTS: Out of 7,199 identified articles, 13 met the inclusion criteria. Among the selected articles, 12 were from Asia and one from Africa. The review identified eight measurement tools: Gini coefficients and Lorenz curve, Robin Hood index, Theil index, concentration index, Workload Indicator of Staffing Need method, spatial autocorrelation analysis, mixed integer linear programming model and cohortcomponent model. These tools rely on fundamental data concerning population and physician numbers to generate outputs. Additionally, five studies employed a combination of these tools to gain a comprehensive understanding of physician distribution dynamics. CONCLUSION: Measurement tools can be used to assess physician distribution according to population needs. Nevertheless, each tool has its own merits and limitations, underscoring the importance of employing a combination of tools. The choice of measuring tool should be tailored to the specific context and research objectives.

Refining dietary metabolisable energy and crude protein levels in relation to duck performance and behaviour.

1. The study evaluated the effect of dietary metabolisable energy (ME) content and crude protein (CP) level on the growth performance and behaviour of ducks.2. A total of 720, Cherry Valley ducks were allocated to 36 pens in groups of 20 birds. For the initial period, from 1 to 21 d age, six diets, containing a standard (SME), low (LME) and high (HME) ME of 12.14, 11.93 and 12.35 MJ/kg, and standard (SCP) or high (HCP) CP contents of 210 or 220 g/kg diet, respectively, were mixed. For the period from 22 to 42 d age, the diets contained ME of 12.98 (SME), 12.77 (LME), 13.19 (HME) MJ/kg and the levels of CP were 170 (SCP) or 180 (HCP) g/kg, respectively.3. An ME by CP interaction was seen from 1 to 21 d age in ducks fed HME + HCP diet, which had greater weight gain than those fed LME + SCP (P < 0.05). Compared to LME + SCP, dietary HME decrease feeding but increased walking behaviour compared to LME + SCP and SME + SCP (P < 0.05). High CP in LME and SME diets increased drinking behaviour (P < 0.05), but there was no change in HME diet. Compared to LME, feeding HME reduced ground pecking (P < 0.05). Feeding HME reduced feeding behaviour (P < 0.05) from 22 to 42 d age. During the same period, standing behaviour was reduced in HCP + LME (P < 0.05). Drinking was reduced in LME + SCP compared to SME + HCP and HME + HCP (P < 0.05).4. A diet formulated with HME and HCP is effective for enhancing growth performance of ducks aged 1-21 d and saving time for feeding or ground pecking, which may induce spending more time on other activities.

Exploring nanocellulose frontiers: A comprehensive review of its extraction, properties, and pioneering applications in the automotive and biomedical industries.

Material is an inseparable entity for humans to serve different purposes. However, synthetic polymers represent a major category of anthropogenic pollutants with detrimental impacts on natural ecosystems. This escalating environmental issue is characterized by the accumulation of non-biodegradable plastic materials, which pose serious threats to the health of our planet's ecosystem. Cellulose is becoming a focal point for many researchers due to its high availability. It has been used to serve various purposes. Recent scientific advancements have unveiled innovative prospects for the utilization of nanocellulose within the area of advanced science. This comprehensive review investigates deeply into the field of nanocellulose, explaining the methodologies employed in separating nanocellulose from cellulose. It also explains upon two intricately examined applications that emphasize the pivotal role of nanocellulose in nanocomposites. The initial instance pertains to the automotive sector, encompassing cutting-edge applications in electric vehicle (EV) batteries, while the second exemplifies the use of nanocellulose in the field of biomedical applications like otorhinolaryngology, ophthalmology, and wound dressing. This review aims to provide comprehensive information starting from the definitions, identifying the sources of the nanocellulose and its extraction, and ending with the recent applications in the emerging field such as energy storage and biomedical applications.

Health Problems of Bangladeshi Tannery Workers.

Tanners are exposed to raw hides as well as to various toxic chemicals. The study was intended to find out the health problems among tannery workers. This descriptive cross-sectional study was conducted in 2019 among 223 workers working with raw hides and chemicals selected by stratified random sampling in ten tanneries of Leather Industry Area, Hemayetpur, Savar, Dhaka, Bangladesh. Data were collected by the principal investigator after taking informed written consent from the tanners using a pre-tested interview schedule and a check-list. Data were cross-checked for consistency and accuracy. All relevant ethical issues including approval from Institutional Review Board (IRB), and data quality assurance issues were taken into consideration. Analysis of data was carried out by using computer software SPSS version 20.0 with anonymity. Descriptive statistics were used to describe the data, while Chi-square test was carried out to measure statistical association. As many as 97(43.5%) workers were in age group of 15 to 24 years with a mean age of 28.4±9.5 years. An overwhelming majority 204(91.5%) were males, three-fifths 134(60.1%) of the workers were married, while 213(95.5%) tanners had religion Islam. Majority 122(54.7%) tanners had primary level of education, whereas 56(25.1%) had secondary level and 44(19.7%) had no formal schooling. The mean monthly family income was 13744.4±3485.5 Taka. More than three-fourths 170(76.2%) workers had more than four family members with over half 114(51.1%) of the workers were smokers. Of 223, over half 124(55.6%) of the workers were affected with at least one health problem. Majority of the workers suffered from skin diseases (51.6%), musculoskeletal disorders (33.1%), gastrointestinal problems (22.6%), chronic headache (14.5%) and respiratory problems (14.5%). Only 9(4.0%) workers had pre-placement orientation, while 196(66.4%) workers did not notice the necessity for pre-placement training. Of ten tanneries, cent per cent had foul smell, 80.0% each had poor lighting and discomfort temperature, 60.0% had intolerable noise, 50.0% were with poor ventilation system, and only 30.0% had adequate waste management facilities. The tanneries did not have medical facilities even for emergency conditions. Health problems are significantly associated with job duration (p<0.01), working sections (p<0.05) and smoking status (p<0.001) of the workers. The overall environment of the tanneries is far from satisfactory. Skin diseases, musculoskeletal disorders, gastrointestinal problems, chronic headache and respiratory diseases are the common identified health problems. A considerable number of workers are unconcerned for the pre-placement orientation, and do not use Personal Protective Equipments (PPEs). As a rule, Personal Protective Equipments (PPEs) are not made available to workers by the tannery authorities, and lack of treatment facilities of the tanneries is a common place.

Comparing various cut-offs of aspartate aminotransferase-to-platelet ratio index (APRI) in liver cirrhosis diagnosis among hepatitis C patients in Malaysia.

INTRODUCTION: A major challenge in providing hepatitis C virus (HCV) treatment at primary healthcare clinics is the lack of radiological facilities to guide the decision making of liver cirrhosis (LC). This study aimed to compare the performance of three commonly used cut-offs of the aspartate aminotransferase-to-platelet ratio index (APRI) in diagnosing LC among hepatitis C patients in Malaysia. METHODS: This cross-sectional study was based on the data collected from the Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) study in 25 primary healthcare clinics across three regions of Malaysia. The findings of biochemical tests were used to calculate the APRI for each study participant. Transient elastography was used as a standard reference for the diagnosis of cirrhosis. The area under the receiver operating curve (AUROC) was used to determine the discriminative ability of APRI in both HCV mono-infected and HCV/HIV co-infected patients. The diagnostic performance of APRI at three different cutoffs (>1.0, ≥1.5 and >2.0) were also evaluated. RESULTS: This study included 867 HCV-RNA-positive patients, 158 (16.1%) were co-infected with HIV. For the HCV mono-infected patients, the sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) for the cut-off of >1.0 were 61.8%, 88.7%, 73.8% and 81.9%, and for the cut-off of ≥1.5, 45.6%, 97.0%, 88.7% and 77.6%, respectively. A much lower sensitivity (29.9%) was observed for the cut-off of >2.0. The diagnostic accuracy of APRI at the cut-off of ≥1.5 in the HCV/HIV co-infected patients was relatively suboptimal. CONCLUSION: APRI, with a cut-off of ≥1.5, can more accurately predict LC among hepatitis C patients in Malaysia. However, additional physical examination and laboratory assessment are likely to be required to support the diagnosis, especially in those with HCV/HIV co-infection.

Efficacy of Itraconazole in the Prevention of Recurrence of Tinea Versicolor: A Three Year Follow Up.

Pityriasis versicolor (PV) also known as tinea versicolor, which is chronic and superficial fungal skin disease caused by Malassezia yeasts. A permanent cure may difficult to achieve and this may explain the long-term nature of the disease. Consequently, a preventive treatment regimen may help to prevent the recurrence of pityriasis versicolor. Whether, the recurrence of tinea versicolor could be prevented by monthly itraconazole treatment regimen after a short course of itraconazole therapy. Open treatment followed by a randomized, single blind placebo control trial. Multi-center trial was characterized by an open, active treatment phase with itraconazole followed by a randomized placebo controlled treatment for prevention of recurrence. A total 200 patients (150 male and 50 female) were included in this study and was given 200mg itraconazole daily for 7 days (treatment phase). Patients in whom tinea versicolor was mycologically cured divided into Group A and Group B. Active open treatment was followed by preventive itraconazole treatment 200mg twice daily in Group A and placebo in Group B monthly for 6 consecutive months. The patients were diagnosed clinically and confirmed by Wood's lamp examination and KOH microscopy. Clinical improvement in 90%, negative Wood's lamp examination in 86.5% and Mycological cure in 85.5% were found at the end of open treatment. The mycological cure, 171 subjects were taken into this study for preventive treatment phase and divided into two groups- Group A & Group B. Preventive treatment was given in Group A and placebo in Group B. After the preventive treatment, the end point (After 6 months), clinical improvement, negative Wood's lamp examination and mycological cure were found in 81(90%), 76(84.4%) and 75(83.3%) in Group A and 44(55%), 41(51.3%) and 42(52.5%) in Group B respectively. In preventive treatment phase, 1 patient in Group A did not complete the study. No patient experienced any serious adverse effects. Prevention of recurrence of Pityriasis versicolor with itraconazole is as effective as treatment.

Interleukin-28 Polymorphism: Ethnic variations and the response to chronic hepatitis C treatment in Malaysia.

No abstract provided.

Moisture Damage Modeling in Lime and Chemically Modified Asphalt at Nanolevel Using Ensemble Computational Intelligence.

This paper measures the adhesion/cohesion force among asphalt molecules at nanoscale level using an Atomic Force Microscopy (AFM) and models the moisture damage by applying state-of-the-art Computational Intelligence (CI) techniques (e.g., artificial neural network (ANN), support vector regression (SVR), and an Adaptive Neuro Fuzzy Inference System (ANFIS)). Various combinations of lime and chemicals as well as dry and wet environments are used to produce different asphalt samples. The parameters that were varied to generate different asphalt samples and measure the corresponding adhesion/cohesion forces are percentage of antistripping agents (e.g., Lime and Unichem), AFM tips K values, and AFM tip types. The CI methods are trained to model the adhesion/cohesion forces given the variation in values of the above parameters. To achieve enhanced performance, the statistical methods such as average, weighted average, and regression of the outputs generated by the CI techniques are used. The experimental results show that, of the three individual CI methods, ANN can model moisture damage to lime- and chemically modified asphalt better than the other two CI techniques for both wet and dry conditions. Moreover, the ensemble of CI along with statistical measurement provides better accuracy than any of the individual CI techniques.

Histopathological diagnoses in soft tissue tumours: an experience from a tertiary centre in Malaysia.

Soft tissue tumours are a group of remarkably diverse neoplasms that frequently pose significant diagnostic challenges to general pathologists. This study aimed to compare the agreement of histopathological diagnoses between general pathologists from various referral institutes and the referred soft tissue pathologist in a tertiary centre. The common discrepancies and their causes are also presented here. A retrospective study was conducted on 243 cases of potential soft tissue tumours referred to Hospital Kuala Lumpur, Malaysia over a period of 5 years. Reports by the referring pathologists and the soft tissue pathologist were compared based on tumour classification and tumour behaviour. Overall, there was moderate agreement in soft tissue tumour diagnoses in both tumour classification (weighted κ = 0.423) and tumour behavior (weighted κ = 0.548). The highest agreement of tumour classification was seen in the adipocytic tumours (21/28 cases), Ewing sarcoma (5/7 cases) and smooth-muscle tumours (3/5 cases). The highest rates of discrepancies were the so-called fibrohistiocytic tumours (7/11 cases), vascular tumours (9/15 cases) and undifferentiated/ unclassified sarcomas (19/32 cases). Full agreement for tumour behaviour was seen in 178 cases and there were 21 cases of zero agreement. Liposarcoma, alveolar soft part sarcoma and benign fibrous histiocytoma were the most frequent benign/malignant diagnostic discrepancies. The most common causes of discrepancy were wrong morphological interpretation followed by insufficient immunohistochemical stains performed. In conclusion, review of diagnosis by a pathologist specialized in soft tissue improves the quality of diagnosis in these heterogenous and rare tumours. A good panel of immunohistochemical stains with additional molecular study is crucial in the general hospital laboratories practice.

Sonographically abnormal placenta: an association with an increased risk poor pregnancy outcomes.

BACKGROUND: The placenta is a most interesting but unfortunately often ignored and misunderstood organ. Placental abnormalities, therefore, can be an "early warning system" for fetal problems. A complete prenatal sonographic examination of the placenta is an essential component as its abnormalities can have a direct effect on fetal or maternal outcomes, obstetrical management and future fertility. OBJECTIVE: To determine whether any association exists between the finding of an increased thickness of placenta, abnormal placenta shape, placental calcification, placental lake and abnormal cord insertion site at 20-22 and 30-32 weeks gestation with an increased risk of uteroplacental complications or a poor pregnancy outcome. METHODOLOGY: A real-time ultrasound was used at the time of detail scan (at 20-22 weeks gestation) and at 30-32 weeks gestation to look for placenta appearance, fetal growth and anomaly. The main outcome measures were risk of hypertension disease in pregnancy, fetal growth restriction and poor fetal outcomes such as low Apgar score and low cord pH. RESULT: The majority of the participants were Malay (77.9%). Abnormal placenta found at both gestations were placental lakes and thickness, and only one case had marginal cord insertion. Approximately 6% of the cases were confirmed placenta previa. No abnormal shape or abnormal calcification found at both gestations. About 10% patient developed hypertensive disease in pregnancy, 15% of the fetus was found to have growth restriction and another 16% have low umbilical cord pH. Majority of them delivered at term (90%) and via vaginal delivery (81%). There was no significance between presence of abnormal placental lake and thickness at both gestations with the maternal and fetal outcome. CONCLUSION: Presence of abnormal placental thickness and lakes at 30-32 weeks scan associated with maternal hypertensive disease, fetal growth restriction and low umbilical cord pH, however these were not statistically significant.

Quality of Life in Children with Asthma in Bangladesh.

Asthma is a public health problem that adversely affects different aspects of quality of life. Childhood asthma is common in Bangladesh affecting their lifestyle. The objective of the study was to assess health-related quality of life in children with bronchial asthma. A descriptive, cross-sectional study was carried out from January 2014 to December 2014 at the Outpatient Department of National Asthma Centre, Mohakhali, Dhaka among hundred sixty-two purposively selected children of both sexes with bronchial asthma aged from 7 to 17 years. Data were collected through interview with children or their parents using an interviewer-administered questionnaire based on Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Data were analyzed by computer software SPSS version 16.0. The mean age was 12.5 years with a standard deviation (SD) of 2.9 years. Overwhelming majority 157(96.9%) of children were literate, while only 5(3.1%) children were illiterate. Eighty (49.4%) children were male, while 82(50.6%) female. As many as 148(91.4%) children were students, while 10(6.2%) children were engaged in some type of job and 4(2.5%) children had no occupation. Parents of 145(89.5%) children were currently married, while 10(6.2%) children had single parent and 7(4.3%) children's parents were divorced or separated. Quality of life in children with asthma decreases with age as the disease intensity increases with age. Female asthmatic children had lower overall score of Quality of life (p=0.017), as well as lower activity domain score (p<0.001). Emotional domain score was found lower in children with single parent (p=0.021) and low monthly family income (p<0.001). Furthermore, children with lower monthly family income and working children had lower Quality of life score in all domains.

An Evaluation of Faculty Wise Teaching Performance in a Public Medical College of Bangladesh.

Teaching is a complex and demanding activity that involves Mastery of content, classroom control and techniques of organization and command of teaching skills. Teachers' continuous engagement in learning, skill acquisition and refinement to practice is essential for meeting student learning needs. Medical education is principally centered on the transmission of medical knowledge and assisting medical students to acquire the necessary skills and attitudes associated with medical practice. Evaluation of teaching is important in the teaching-learning process. The medical profession demands to be increasingly concerned with evaluation of teachers' performance as a part of its accountability. This study was designed to evaluate teaching performance in the department of Pharmacology, Forensic Medicine, Microbiology, Community Medicine and Pathology in Mymensingh Medical College and this descriptive cross sectional study was conducted among 94 students of 5th year MBBS students (session 2011-2012) of Mymensingh Medical College, Bangladesh from January 2016 to June 2016. A semi-structured self-administered questionnaire was used for collection of data. All the respondents provided opinion regarding scholarship of teachers, methods of presentation, communication and interaction, learning, coverage of contents and approachability by a 5 points rating scale. Attained score was variable in the context of different statements and different faculties. Students were also asked to provide suggestions for improvement of teachers' performance in each subject. Remarkable number of the students demanded for deployment of subject-specific teachers in adequate number. A significant number of students called for more practical classes in Pathology, Microbiology and Pharmacology. They also desired for the improvement of teaching quality and student friendly attitude from the teachers. A significant number of students opined that teaching materials and other logistics in the class rooms and even the class rooms were inadequate and need improvement in this regards. Regular conduction of classes by adequate number of teachers having post-graduate degree in the relevant faculty with adequate skill in teaching, student-friendly attitude of the teachers, adequate physical facilities and teaching materials help in improvement of teaching quality.

Occurrence of human respiratory syncytial virus in summer in Japan.

In temperate zones, human respiratory syncytial virus (HRSV) outbreaks typically occur in cold weather, i.e. in late autumn and winter. However, recent outbreaks in Japan have tended to start during summer and autumn. This study examined associations of meteorological conditions with the numbers of HRSV cases reported in summer in Japan. Using data from the HRSV national surveillance system and national meteorological data for summer during the period 2007-2014, we utilized negative binomial logistic regression analysis to identify associations between meteorological conditions and reported cases of HRSV. HRSV cases increased when summer temperatures rose and when relative humidity increased. Consideration of the interaction term temperature × relative humidity enabled us to show synergistic effects of high temperature with HRSV occurrence. In particular, HRSV cases synergistically increased when relative humidity increased while the temperature was ⩾28·2 °C. Seasonal-trend decomposition analysis using the HRSV national surveillance data divided by 11 climate divisions showed that summer HRSV cases occurred in South Japan (Okinawa Island), Kyushu, and Nankai climate divisions, which are located in southwest Japan. Higher temperature and higher relative humidity were necessary conditions for HRSV occurrence in summer in Japan. Paediatricians in temperate zones should be mindful of possible HRSV cases in summer, when suitable conditions are present.

Melt volume flow rate and melt flow rate of kenaf fibre reinforced Floreon/magnesium hydroxide biocomposites.

A study of the melt volume flow rate (MVR) and the melt flow rate (MFR) of kenaf fibre (KF) reinforced Floreon (FLO) and magnesium hydroxide (MH) biocomposites under different temperatures (160-180 °C) and weight loadings (2.16, 5, 10 kg) is presented in this paper. FLO has the lowest values of MFR and MVR. The increment of the melt flow properties (MVR and MFR) has been found for KF or MH insertion due to the hydrolytic degradation of the polylactic acid in FLO. Deterioration of the entanglement density at high temperature, shear thinning and wall slip velocity were the possible causes for the higher melt flow properties. Increasing the KF loadings caused the higher melt flow properties while the higher MH contents created stronger bonding for higher macromolecular chain flow resistance, hence lower melt flow properties were recorded. However, the complicated melt flow behaviour of the KF reinforced FLO/MH biocomposites was found in this study. The high probability of KF-KF and KF-MH collisions was expected and there were more collisions for higher fibre and filler loading causing lower melt flow properties.

Immunochemical faecal occult blood test for colorectal cancer screening: a systematic review.

A systematic review on the effectiveness and costeffectiveness of Immunochemical faecal occult IFOBT for CRC screening was carried out. A total of 450 relevant titles were identified, 41 abstracts were screened and 18 articles were included in the results. There was fair level of retrievable evidence to suggest that the sensitivity and specificity of IFOBT varies with the cut-off point of haemoglobin, whereas the diagnostic accuracy performance was influenced by high temperature and haemoglobin stability. A screening programme using IFOBT can be effective for prevention of advanced CRC and reduced mortality. There was also evidence to suggest that IFOBT is cost-effective in comparison with no screening, whereby a two-day faecal collection method was found to be costeffective as a means of screening for CRC. Based on the review, quantitative IFOBT method can be used in Malaysia as a screening test for CRC. The use of fully automated IFOBT assay would be highly desirable.

Immunochemical faecal occult blood test for colorectal cancer screening: a systematic review

A systematic review on the effectiveness and costeffectiveness of Immunochemical faecal occult IFOBT for CRC screening was carried out. A total of 450 relevant titles were identified, 41 abstracts were screened and 18 articles were included in the results. There was fair level of retrievable evidence to suggest that the sensitivity and specificity of IFOBT varies with the cut-off point of haemoglobin, whereas the diagnostic accuracy performance was influenced by high temperature and haemoglobin stability. A screening programme using IFOBT can be effective for prevention of advanced CRC and reduced mortality. There was also evidence to suggest that IFOBT is cost-effective in comparison with no screening, whereby a two-day faecal collection method was found to be costeffective as a means of screening for CRC. Based on the review, quantitative IFOBT method can be used in Malaysia as a screening test for CRC. The use of fully automated IFOBT assay would be highly desirable.

Hypersensitivity reaction to all drugs of category-1 anti-tuberculosis regime in an adult tuberculosis patient.

Adverse drug reaction to tuberculous chemotherapy is not an uncommon problem. Usually it occurs to single drug and can be treated easily with minimal intervention. We follow WHO recommended guideline for National Tuberculosis Control Programs to treat these adverse reactions. Here we found an adult who has been suffering left sided pleural tuberculosis developed anaphylactic reaction to first dose of category-1 anti-TB regime. Later on it was found that he could not even tolerate smaller challenging doses of isoniazide, Ethambutol, Rifampicin and Pyrazinamide separately. It became very difficult to choose an alternate regime for this patient. Lastly a regime with levofloxacin, streptomycin and clarithromycin was give to treat him and patient was recovered with this regime successfully. This experience will help in management of unusual drug reactions to anti-tuberculosis drugs.

Pulmonary metastases of a papillary adeno-carcinoma of ovary in a pregnant lady.

A 28 years young lady admitted to National Institute of Diseases of Chest and Hospital (NIDCH), Dhaka with the complaints of respiratory distress and cough for 2 months. She was in her last trimester of first pregnancy when she becomes dyspneic on exertion and at night. Gradually it increases in time and she become unable to walk when she consulted with specialists in Barisal. She was examined clinically and radiographically and found some opacity on both lung fields. She was on several antibiotics, but got no improvement. In the meantime, an emergency caesarean section was done to have a healthy baby and patient came to NIDCH for this unexplained breathlessness and cough. She was severely dyspneic, tachypnoic, cyanosed. There were bilateral coarse crepitations, bilateral opacities predominantly on both lower and middle zones of both lungs obscuring costo-phrenic angles on chest X-rays. CT scan of chest shows bilateral reticulo-nodular shadows with a homogenous opacity on right lower lung which enhances after contrast scanning. A CT guided FNAC was done from that opacity which revealed a papillary adeno-carcinoma with psammoma bodies on cytopathological study. Thereafter, to explore the primary site, thyroid gland, abdominal organs was assessed adequately and only positive finding was raised CA-125 (706 IU/ml) which was consistent with ovarian cancer. In this way, a primary ovarian carcinoma in a pregnant young lady with normal sized ovary that metastasizes to lung causing bilateral pleural effusion and lymphangitis carcinomatosa was explored. This was an unusual presentation of ovarian papillary adeno-carcinoma with cough and breathlessness at the last trimester of pregnancy in absence of any abdominal mass.

A comparison of genotype and markers of disease severity of chronic hepatitis C in patients with and without end-stage renal disease.

INTRODUCTION: This study was conducted to compare the genotype and markers of disease severity of chronic hepatitis C (CHC), namely viral load, alanine transaminase (ALT) levels and histopathological findings on liver biopsy, in patients with and without end-stage renal disease (ESRD). METHODS: This was a cross-sectional retrospective comparative study that included ESRD patients on haemodialysis and non-ESRD patients with CHC who underwent liver biopsy between January 2004 and December 2006. Blood tests for viral load (VL) (hepatitis C virus, ribonucleic acid, polymerase chain reaction), genotyping and ALT were administered. VL was grouped into low (less than 5 log10) and high (more than or equal to 5 log10) VL, genotype into G1 and 2, 3, 4, and ALT into normal and elevated ALT. Necroinflammatory activity was grouped into mild (G0-6) and moderate/severe (G7-18) activity, and fibrosis into mild (S0-2) and moderate/severe (S3-6) fibrosis. These variables were compared between the two groups. RESULTS: Genotype 1 was significantly higher in ESRD patients than in non-ESRD patients, in whom genotypes 2, 3 and 4 were higher. Although the proportion of patients with high VL was greater and the duration of CHC was longer in the ESRD group, the ALT levels were lower and the histopathological grading of necroinflammatory activity and stages of fibrosis were less severe in ESRD compared to non-ESRD patients. CONCLUSION: The lower levels of ALT observed in CHC patients with ESRD translate to histopathological benefits.

Safety and efficacy of an escalating dose regimen of pegylated interferon alpha-2b in the treatment of haemodialysis patients with chronic hepatitis C.

Chronic hepatitis C is associated with increased morbidity and mortality in persons undergoing haemodialysis. This single-arm, open-label clinical trial investigated the safety and efficacy of an escalating dosage regimen of pegylated interferon (PEG-IFN) alpha-2b in this patient population. Patients with chronic hepatitis C who were undergoing haemodialysis began treatment with PEG-IFN alpha-2b at a dose of 0.5 microg/kg/week, which was increased every 4 weeks to a maximum of 1 microg/kg/week. Treatment duration was 24 weeks for patients with genotype (G) 2 or 3 infection and 48 weeks for patients with G1 infection. The primary end point was sustained virological response (SVR). Of 46 patients screened, 34 (G1: 70.6%; G3: 29.4%) were treated and 23 (67.6%) completed treatment. Overall, 85.3% of patients experienced early virological response, 52.9% experienced end-of-treatment response, and 50% attained SVR, with a trend toward higher SVR rates in G3 compared with G1 patients (80%vs 37.5%; P = 0.06). Anaemia was the main reason for discontinuation of treatment. Patients with chronic hepatitis C who are undergoing haemodialysis can be successfully treated with an escalating dosage regimen of PEG-IFN alpha-2b monotherapy. G3-infected patients can attain high rates of SVR with only 24 weeks of therapy.