Coagulation profile in patients with chronic liver disease

Background: Chronic liver disease (CLD) is defined as a process of slow and continuous destruction and regeneration of the hepatic parenchyma giving rise to fibrosis and cirrhosis. When it has markedly progressed, it may present with clinical bleeding due to reduction in levels of procoagulant factors, barring some like factor VIII and von Willebrand factor, which are elevated. It is essential to observe that reduced levels of the procoagulants are accompanied by decrease in levels of anticoagulants such as antithrombin and protein C. Under normal conditions, the coagulation machinery is balanced, but the phenomenon of the simultaneous reduction of procoagulants as well as anticoagulants in patients with CLD has been an unsolved puzzle since long. Objective: This study was undertaken to study the relevance and significance of first-line coagulation tests (prothrombin time [PT] and activated partial thromboplastin time [aPTT]) in relation to bleeding manifestations in patients with CLD, to classify the cases of CLD enrolled on the basis of etiology, to study the platelet count, PT, and aPTT values of the cases, and to calculate the Child–Pugh (CP) and model for end-stage liver disease (MELD) scores for all the patients and stratify them accordingly. Materials and Methods: It was a prospective observational study including 40 patients known to be diagnosed with CLD. CP score and MELD were calculated for all. Values of coagulation parameters were compared in patients with and without cirrhosis, in patients belonging to different CP classes, those with low and high MELD scores, and patients with or without upper gastrointestinal (UGI) bleed. Results: Means of PT and aPTT were compared in patients with and without cirrhosis where it was found that there was no statistically significant prolongation of PT or aPTT in patients with cirrhosis compared to those without. We also studied the values of PT and aPTT through increasing grades of CP score and found statistically significant difference between values of PT between those belonging to Class A versus Class C. It was observed that the difference of the mean of PT of the two groups (with MELD <15 and above 15) is statistically significant, whereas it is not true in case of aPTT. Conclusions: The study showed no significant alterations overall in patients with CLD except those in advanced CP classes and those with high MELD scores. They were not significant in patients presenting with UGI bleed, a common manifestation in cirrhotic patients, although those constituted a very small part of the study group. These indices alone are insufficient to include as part of their prognostic and clinical work up to predict bleeding.

pH-induced in situ gelling system of an anti-infective drug for sustained ocular delivery.

Recently, in situ gel formation has been extensively studied to enhance ocular bioavailability and the duration of drug activity. Poor ocular bioavailability of drugs (<1%) from conventional eye drops is mainly due to the precorneal loss factors that include rapid tear turnover, nonproductive absorption, transient residence time in the cul-de-sac, and the relative impermeability of the drugs to corneal epithelial membrane. These problems may overcome by the use of in situ gel-forming systems that are instilled as drops into the eye and undergoes sol-gel transition in the cul-de-sac. In this study, in situ gelling system of Gatifloxacin were prepared using polymers carbopol 940 (0.1% to 0.5% w/v) and HPMC E4M (0.2% to 0.6% w/v). The developed formulation was characterized for various in vitro parameters such as clarity, temperature, pH, tonicity, sterility, rheological behavior, drug release profile, transcorneal permeation profile, and ocular irritation. Developed formulation was clear isotonic solution, converted into gel at temperatures above 35 °C and pH 6.9–7.0. The results demonstrated that the carbopol/ HPMC mixture can be used as an in situ gelling vehicle to enhance the ocular bioavailability of Gatifloxacin. The developed system is a viable alternative to conventional eye drops for the treatment of Bacterial conjunctivitis and various other ocular infections.

Spectrophotometric analysis of bovine serum albumin in presence of synthesized 1-(2’-thienyl)-(substitutedphenyl)-2-propen-1-ones.

Serum albumin an important constituent of blood, involved in transportation of a number of compounds interacts with a vast array of chemically diverse ligands, including drugs by various binding sites. Chalcones, 1,3-diaryl propenones have been found to possess diverse pharmacological activities. In the present work we report binding of bovine serum albumin with some chalcones. Series of 1-(2’- thienyl)-3(substitutedphenyl)-2-propen-1-ones were synthesized by the Claisen-Schmidt condensation and their effect was observed on bovine serum albumin. It was found that the synthesized chalcones interacted with bovine serum albumin irrespective of the nature and position of the substituent.

Evaluation of various diagnostic signs on percutaneous transhepatic cholangiography in obstructive jaundice.

Twenty patients of obstructive jaundice were subjected to percutaneous transhepatic cholangiography (PTC) of which 17 were operated on. Patients were divided in 4 groups according to the site of obstruction. The diagnostic signs observed were: Complete block with interface having convexity downwards (4), convexity upwards (3), biconcave caudal cut off (6), smooth edged cut off (one), irregular edged cut off (one) and non-specific appearance (one); incomplete block with interface having convexity upwards (one); biconcave caudal cut off (2) and multiple smooth central filling defects (2). In one case there was incomplete obstruction at two sites giving rise to two different signs. PTC was 100% correct in accurately telling the site of lesion. As regards the nature of the lesion the diagnosis on PTC was found correct in 15 out of 17 cases (88.5%).

Prevalence of hyperuricaemia in clinical cases at Bahawalpur

A total of 184 patients were examined for their blood uric acid level. Sixty two [33.69%] were found to be hyperuricemic while none was found to be hypouricemic. Analysis of the results indicated a higher risk of hyperuricemia in patients, in age group of 30 and above especially females and those with O blood group. The prevalence of hyperuricemia was also higher in patients using a protein-rich diet, being poor with respect to their socio-economic position and those suffering from gout, rheumatic fever or liver and kidney diseases

Cytotoxigenicity in Salmonella serovars.

Twenty two strains of Salmonella belonging to eight different serovars, namely S. enterica subsp. enterica serovar S. typhimurium, S. nchanga, S. newport, S. virchow, S. bovismorbificans, S. seftenberg, S. weltevreden and S. indiana, isolated from foods of animal origin, were tested for their cytotoxicity on MDBK and Vero cell-lines. Although all the strains were found to be cytotoxic for both the cell-lines, their cytotoxic activity varied greatly. A dose-related cytotoxic effect was observed. Polymyxin B sulphate @.25 mg/ml in PBS, pH 7.2), urea (8M in Tris-HCl buffer, pH 8.2) and cell-sonication were found to augment the release of cytotoxin.

Biological standardization of pollen allergens from India.

Standardization of allergens are achieved by in vitro and in vivo methods. Some of the allergens from Western countries are standardized using biological potency of the extracts but no attempt has been made till now to standardize any of the pollen extracts from India based on biological units. Therefore, we have attempted to standardize two important pollen allergens Ricinus communis and Holoptelea integrifolia by biological methods. Broadly the methods adopted by Dreborg and Grimmer (1983) was followed. Skin prick tests were carried out with the extracts of R. communis and H. integrifolia on 15 allergic patients in five three fold log dilutions starting with 1:10, in 50% glycerinated buffer. Glycerinated buffer (50%) and histamine dihydrochloride (1 mg/ml) were used as negative and positive controls, respectively. The mean wheal diameter obtained with different concentrations showed a gradual systematic fall with increase in dilution. The mean relative diameter (% of histamine reaction) varied from 124.1 +/- 8.9 to 33.7 +/- 6.1 and 78.9 +/- 5.5 to 21.4 +/- 3.8 with the highest and lowest concentrations of R. communis and H. integrifolia pollen antigens, respectively. The histamine equivalent concentration of antigen 1,000 Biological Units (BU) obtained for crude pollen extracts of R. communis and H. integrifolia was 1:17 and 1:22 respectively.

Poliomyelitis in vaccinated children.

Fifty-two children who had received at least 3 properly spaced doses of oral polio-vaccine and had developed acute poliomyelitis inspite of vaccination were studied clinically and serologically. This group (A) was compared with 28 children with poliomyelitis who had not received any vaccination (Group B). A much higher incidence of provocative injection and a better muscle power on presentation was seen in Group A as compared to Group B. Polio-virus type 2 was the commonest etiological agent in Group A (42.3%) whereas type I virus was most commonly seen in Group B (78.6%). A total 53.8% of cases of Group A had protective antibody titres to at least one poliovirus type in the acute phase sera, compared to only 4% from Group B. Six per cent from Group A had protective antibodies to all three virus types, disease in these cases was caused by non-polio agents. Two cases in Group A were possibly vaccine induced paralysis. Recovery, after 60 days, was much better in Group A as compared to Group B. Mortality in the two groups was comparable.