COLLABORATIVE TEAM IN THE MANAGEMENT OF DYSPHAGIA

Dear Editor, Swallowing is an essential requirement for life. Eating is not only a practical act (i.e., obtaining the nutrition necessary for survival) but also involves social interaction. Having meals with family and friends is almost universally necessary for personal interactions1. Dysphagia is derived from the Greek Language "Dys" which means “difficulty or dysfunction" and "Phagia" means "to eat". However, it is defined as difficulty in processing or swallowing food from mouth to stomach2.

Virologic Response and Safety of Hepatitis C Teatment Regimens in Patients With Hcv 3A Genotype

HCV has been on the top of virus-induced liver diseases in many parts of the world and has gained endemic proportions in our population. Frequency of HCV in Pakistan is significantly higher (4.7%) when compared to the populations of same ethnicity. The hepatitis C virus (HCV) is a small enveloped, single-stranded RNA virus. It is a member of the Hepacivirus genus in the family Flaviviridae. The RNA encodes a large polypeptide of about 3,000 amino acids in a single continuous open reading frame (ORF) which is flanked at the 5'' and 3'' ends by non-translated regions (5'' UTR). Viral load suppression reduces risk of hepatitis C liver morbidity and mortality and prevents progression to cirrhosis, hepatocellular carcinoma (HCC), and decompensated liver disease requiring liver transplantation. Patient race/ethnicity and HCV genotypes also affected the risk of future liver events and death. Multivariate analyses examining socio-demographic and clinical characteristics found that race was the only variable significantly associated with the difference in response rates. So we designed a study to find that how does our local population respond to Hep C treatment regimens and which treatment regimen is effective and safe. Moreover, we also wanted to know that either viral load was correlated to treatment outcome or not. We also planned to do the Pharmacoeconomic analysis of treat regimens. In our study we included adult male / female patients who were seropositive for HCV RNA were tested with real time PCR after an informed written consent. Patients with chronic liver disease, decompensated cirrhosis, anemia (hemoglobin concentration, less than 12 g per deciliter in women and less than 13 g per deciliter in men), psychiatric conditions, seizure disorders, cardiovascular disease, poorly controlled diabetes mellitus, or autoimmune diseases were excluded from the study. Initially 104 patients were evaluated for genotypes and found that 90% of the cases in our local population were infected with HCV 3a genotype. Based on specific prevalence it was decided to compare two treatment regimens (Peg INF+RV & INF+RV) only in patients infected with HCV 3a genotype. We evaluated these treatment regimens for the efficacy and safety both. The required data was recorded on structured data collection form. Their Virologic response was measured at week 0, week 4, week 12, week 24 and week 48 to evaluate treatment efficacy. The initial viral load was also compared with the final out come of the therapy. After the end of the therapy these patients were followed for sustained response. LFTs, RFTs and hematologic parameters were measured on regular intervals to evaluate drug safety. We also did pharmacoeconomic analysis of both treatment regimens being used in our local population to treat Hepatitis C virus infected patients. Our study concluded that though INF+RV treatment regimen was cheaper but Peg INF+RV treatment regimen was more affective in 3a genotype. As far as treatment safety was concerned it was comparable in both regimens. The Virologic response can be used to modify duration of therapy. Moreover, fatty liver can be used as a predictor to assess the final out come of the treatment.