Human leukocyte antigen class I alleles can predict response to pegylated interferon/ribavirin therapy in chronic hepatitis C Egyptian patients

Racial differences and broad spectrum response to anti-hepatitis C [anti-HCV] therapy suggest a possible role for host genetic diversity in treatment outcomes. We aim to determine the association and predictive value of certain human leukocyte antigen [HLA] class I alleles with either susceptibility to viral clearance or persistence following pegylated interferon [Peg-IFN] plus ribavirin therapy in chronic hepatitis C [HCV] genotype 4 patients in Egypt. This study included 200 unrelated chronic HCV patients who received Peg-IFN plus ribavirin therapy [112 patients with sustained virological response [SVR] and 88 non-responders [NR]]. Serological testing of HLA class I antigens [HLA-A and HLA-B alleles] were performed by standard complement-dependent microlymphocytotoxicity assay. The frequency of HLA-A01 was significantly higher in SVR than in NR cases [OR: 0.51; 95% CI: 0.27-0.981; P = 0.042], while the frequency of alleles B38 [P = 0.011], B40 [P < 0.001] and B41 [P < 0.001] was significantly higher in NR cases [OR/95% CI: 7.05/ [1.39-18.01], 10.31/3.14-36.1. On logistic regression analysis, presence of the HLA-A01 allele was associated with SVR [OR: 0.50; 95% CI: 0.28-0.89; P = 0.02] and HLA-B38 can predict non response to therapy [OR: 7.92; 95% CI: 1.67-37.54; P = 0.009] with an overall accuracy of 60%.Severe ??brosis [OR: 3.035; 95% CI: 1.521-6.091; P = 0.002], high viremia [OR: 2.69; 95% CI: 1.11-6.53; P = 0.005] and steatosis [OR: 2.1; 95% CI: 1.002-3.90; P = 0.041] predicted no response with an overall accuracy of 81.8%. HLA-A01 and HLA-B38 alleles are associated with and may have a role in the outcome of response to Peg-IFN plus ribavirin therapy in Egyptian patients diagnosed with chronic HCV infection. The use of immunologic markers to predict the outcome of treatment may help pharmacogenetic personalization of treatment for HCV infection

Impact of medical curriculum on conceptualization of professionalism by residents at a University Hospital, Jeddah, Saudi Arabia

Background: The quality of healthcare outcomes and patient satisfaction are affected by communication skills and professionalism of the physician. Medical curricula have substantial influence on physicians' perception of professionalism

Objectives: The aim of this study was to determine the impact of medical curriculum on the values of the residents at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and their opinions on professionalism and to identify the sources that they describe as most influential in shaping their views

Methods: This cross sectional study was conducted in 2010/2011. A modified version of the questionnaire designed by Blue and colleagues was distributed among the target group [n=201]. Psychometric analysis of the survey tool showed that it was precise and had construct validity

Results: The return rate was 76.6%. The overall means of the attitudes of both male and female residents toward the attributes of professionalism were low. Attitude toward professionalism showed an insignificant difference between male and female residents. Self-reflection ranked first among all studied attributes. Most male [80%] and female [76.7%] residents believed that working with consultants, specialists, and senior residents in the hospital was the main source of their opinions on professionalism. They considered basic science studies and the other extracurricular courses they attended to be the least helpful in developing their opinions

Conclusion and recommendations: Residents at King Abdulaziz University Hospital feel underserved in the area of developing their values toward professionalism during the preclinical years, relying to some extent on their experiences during their clinical years and mainly on their interactions with consultants, colleagues, and hospital staff to develop their sense of professionalism. Given the recent changes in the curriculum adopted by the university, it is recommended to assess the attitudes of the students under the new curriculum toward professionalism and to compare them with those of students under the traditional curriculum