Intrahepatic detection of insulin receptor substrate 2 in chronic hepatitis C patients

Objective: To detect hepatic insulin receptor substrate 2 in chronic hepatitis C patients. Study Design: Comparative study. Place and Duration of Study: Center for research in experimental and applied medicine [CREAM], Department of Biochemistry and Molecular Biology, Army Medical College and Holy Family Hospital Rawalpindi, from Dec 2011 to Nov 2012. Diagnosed patients of chronic hepatitis C were included in the study. Known cases of diabetes mellitus, patients with pancreatic disease and liver pathology other than hepatitis C were excluded from the study

Material and Methods: Twenty seropositive non diabetic HCV infected patients and 10 control subjects were recruited. Liver biopsy specimen was obtained from seropositive HCV patients while blood samples were obtained from controls as biopsy sample was not possible from normal controls. Both types of specimens were studied for detection of insulin receptor substrate 2 [IRS-2]

Results: No alteration in the content of insulin receptor substrate 2 in both seropositive patients and control samples were detected

Conclusion: Hepatitis C virus has no effect on insulin receptor substrate 2 content thus indicating absence of hepatic insulin resistance in patients with HCV infection

Rising cesarean sections rate

Objective: To identify cesarean section [CS] rate in Bahrain and evaluate the reasons for the rise of CS rate

Design: A Retrospective Cross-Sectional Analysis

Setting: Salmaniya Medical Complex, Kingdom of Bahrain

Method: All CS performed from 1 May 2011 to 31 October 2011 were included

The following patients' characteristics and clinical data were documented: age, nationality, maternal weight, parity, gestational age, number of gestation, birth weight and presentation. In addition to primary or repeat CS, indications of the procedure, uterine incision, type of anesthesia provided and immediate complications were documented

Result: One thousand five hundred thirty-five women had CS. Five hundred fifty-eight CS who had complete data were included in the study. The mean maternal age was 32 years +/- [SD 5.8]. Three hundred seventeen [56.8%] patients were Bahrainis

The mean gestational age was 37.1 weeks +/- [SD 2.7] with a mean neonatal birth weight of 3,012 grams +/- [SD 0.750]

One hundred sixty-one [28.9%] were primiparous and 397 [71.1%] were multiparous. Forty-six [8.2%] were performed for multiple gestations

Two hundred eighty-six [51.3%] were primary CS and 272 [48.7%] were repeat CS

The main indications for the procedure were repeat CS in 176 [31.5%], failure to progress in 104 [18.6%], non-reassuring fetal heart rate in 100 [17.9%] and breech presentation in 80 [14.3%]

Conclusion: CS rate is increasing in Bahrain; more than 30% of deliveries in Bahrain are by CS. Physicians should aim to reduce CS rate by lowering primary CS and allowing trial of scar in patients with previous CS

Comparison of low-dose versus conventional-dose prednisolone in the treatment of Idiopathic Thrombocytopenic Purpura [ITP]

Objective: To assess the efficacy of low-dose prednisolone in patients with ITP

Design: A Prospective Randomized Controlled Trial

Setting: Salmaniya Medical Complex, Kingdom of Bahrain

Method: A randomized controlled trial was conducted comparing the conventional-dose to a lowdose of prednisolone [0.25 mg/kg/day]. Forty-one patients with ITP were enrolled in the study; 21 patients were randomized to low-dose prednisolone [group I] and 20 patients received the conventional-dose [group II]

Result: The overall remission rate [OR] for both groups was 78.05%. There was no statistically significant difference between both groups in terms of group overall remission 17 [81%] versus 15 [75%], group complete remission 11 [52.4%] versus 10 [50%] or partial remission rate 6 [28.6%] versus 6 [25%]. In addition, failure rate, relapse rate, and splenectomy rate were similar and not statistically significant. Two [10%] patients developed complications related to steroids therapy, both were in group II, but were not statistically significant

Conclusion: Although the study had a small number of patients, it revealed that low-dose of prednisolone [0.25 mg/kg/day] is as effective as the conventional-dose [1 mg/kg/day] and probably, safer. Accordingly, we recommend the use of low-dose prednisolone as initial therapy for ITP rather than the high-dose