12 October 2004	Tuesday	26 Shaban 1425

KARACHI, Oct 11: Health experts at a seminar on Monday stressed that doctors should ensure careful procurement of disease and drug history of their respective patients coupled with regular follow up to assess the impact of medicines administered to their patients.

The seminar held under the aegis of Sarwar Jehan Zubeiri Institute, Dow University of Health Sciences, on its second day was addressed by Dr Shahab Abid of Aga Khan University, Dr Iftikhar Ahmed of Civil Hospital, Dr Abdul Nadir, Dr Syed Mohammad Munir and Prof Mashkoor Alam of Jinnah Postgraduate Medical Centre.

Dr Shahab Abid in his presentation on drug-induced liver diseases identified drugs as an important cause of severe type of liver diseases in people above 60. These people were further cited to acquire 10 per cent cases of severe hepatitis requiring hospitalization.

He mentioned that local experience revealed 40-year-old patients to be hospitalized with drug-induced liver disease. "Hepatoxicity accounts for less than five per cent of jaundice cases or acute hepatitis and there are even a fewer cases of chronic liver conditions," he observed.

However, he stressed that doctors while prescribing any drug should not only take into account benefits of the same but also extend due consideration towards general health status, age, gender, genetic aspect as well as contraindications of new medicines to be prescribed.

According to him, the factors that influence risk of liver diseases caused by drugs are age, gender, dose of the drug, genetics and drug metabolism. He elaborated that people above 60 were generally found to be more susceptible to the condition.

Dr Shahab Abid further said that some drugs were dose dependent and doctors prescribing the same must be extremely cautious to keep strict and regular vigil as simultaneously there was also an element of blood levels directly related to risk of hepatoxicity.

Aspirin particularly if over dosed, certain categories of anti-depressants, antibiotics, anti-convulsants and several others were identified to cause liver disease if not prescribed and administered with necessary care along with provision for thorough laboratory investigations.

Underlining the need for withdrawal of susceptible drugs as the only option to check the situation, he mentioned that environmental and genetic factors also contributed to the susceptibility of an individual to extremely adverse drug reaction.

Dr Iftikhar Ahmed of Medical Unit-III, Civil Hospital, discussed the causes of non alcoholic fatty liver disease and one of its manifestation termed as non-alcoholic steto hepatitis.

According to him, the conditions with a prevalence of 15 per cent to 30 per cent in the developed world is steadily registered to be growing in the country owing to sedentary life style with adolescent population being significantly vulnerable to it.

Dr Iftikhar said that 55 per cent of patients with non- alcoholic steto hepatitis were found to be inflicted with Diabetes Mellitus Type-II while 95 per cent of them were also found obese.

"Though there happens to be no known cause for non-alcoholic steto hepatitis, yet it is considered to be a prime liver disease," he said. The non-alcoholic fatty liver disease and the non-alcoholic steto hepatitis are identified to be disorders of Lipid Metabolism, he added.

With regard to non-pharmacologic treatment of the non- alcoholic steto hepatitis, he recommended gradual weight loss, ideally between one or two pounds per week, through proper diet control.

As for pharmacological interventions anti-oxidants, insulin sensitive agents and drugs that improve blood flow were recommended. "It is a serious condition which is self-destructive. Treat it and try to eradicate the root causes," Dr Iftikhar remarked.

Also present at the seminar, Dr Abdul Nadir - a US-based expert- termed two grams of sodium-based Pakistani diet as corner stone of therapy for locals inflicted with liver diseases including cirrhosis.

Dr Syed Mohammad Munir, in his presentation on "Update on Chronic Hepatitis-B", cited the condition a major health problem with 350 million people registered to have chronic infections.

He said that liver cancer was the sixth common type of cancer, 50 per cent of which was caused by the HBV. In Asia, he added, the HBV was highly endemic with majority becoming infected during childhood.

Prof Mashkoor Alam, who was chief guest on the second day of the seminar, underscored need for cautious application of drugs emphasized on preventive aspect to contain instances of hepatitis.

At the end, Sarwar Zubeiri Liver Institute Director Dr Rana Masood thanked the speakers and particularly Dr Abdul Nadir for holding OPD clinics at the institute based in DUHS. -APP