Association of response to combined interferon alpha-2b and ribavirin therapy in patients of chronic hepatitis c with serum alanine aminotransferase levels and severity of the disease on liver biopsy.

BACKGROUND: Raised serum alanine aminotransferase (serum ALT) levels indicate active liver disease while liver biopsy has been considered the 'gold standard' for assessing the severity of disease in patients of chronic Hepatitis C. The response of these patients to standard treatment regimen of interferon (INF)-alpha-2b and ribavirin for 24 weeks have been studied. OBJECTIVE: The objective of this study was to evaluate the association of response to combined INF alpha-2b and ribavirin therapy in patients of chronic hepatitis C with serum ALT levels and severity of the disease on liver biopsy. METHODS: This quasi experimental study-was conducted in Department of Physiology at Army Medical College and Military Hospital, Rawalpindi from January 2006 to February 2007. One hundred and seven diagnosed non cirrhotic chronic hepatitis C patients were studied. Prior to the commencement of treatment, qualitative assay of Hepatitis C Virus (HCV) Ribonucleic Acid (RNA) was done by Polymerase chain reaction (PCR). Knodell Histopathological Index (HPI) was determined on liver biopsy. The standard treatment of INF-alpha-2b, 3 million units 3 times a week subcutaneous, and Ribavirin 800-1200 mg per day was given for 24 weeks. Serum ALT levels were determined before the start of treatment and later at weeks 12 and 24. Qualitative assay of HCV RNA was done by PCR at the end of treatment to determine the response to treatment. Statistical analysis was done on SPSS 15. RESULTS: Out of 107 patients of chronic hepatitis C, 92 (69 males, 23 females) patients (84%) responded to INF-alpha-2b and ribavirin therapy and revealed negative qualitative assay of HCV RNA by PCR at the end of 24 weeks of treatment while serum ALT levels were normal in 88% of patients at 12 weeks and in 97% at the end of 24 weeks of treatment. Knodell HPI revealed mild, moderate and severe disease in 47.7%, 39.9% and 13.1% of patients respectively. No association was established between response to treatment and severity of the disease on liver biopsy (p < 0.11) and serum ALT levels (p = 0.09). CONCLUSION: Response to Interferon alpha-2b and ribavirin therapy in patients of chronic hepatitis C is not associated with the levels of serum ALT and the severity of the illness graded on liver biopsy.

The Journal of Ayub Medical College: a 10-year bibliometric study.

OBJECTIVE: To conduct a bibliometric evaluation of the Journal of Ayub Medical College (JAMC), Abbottabad, Pakistan. METHODS: The data of articles, citations and authors of JAMC from 1997 to 2006 were collected and analysed in terms of bibliometric parameters. RESULTS: The number of articles published per year ranges between 27 and 97; most of the articles (47.2%) have 11-20 citations. Three-author contributions ranked the highest (134; 23.43%); the most prolific authors contributed seven articles; 295 (51.57%) of the authors are geographically affiliated to the North West Frontier Province (NWFP), Pakistan; the most popular subject is Internal Medicine; journal self-cited references are 43; 7769 (77.94%) of the citations were from foreign journals; the most productive institution is Ayub Medical College, Abbottabad, Pakistan. CONCLUSION: The number of papers published in JAMC per issue has been increasing over the last 10 years, and the core region is NWFP, Pakistan. Original articles are the main type of papers for this journal. The publication is open for all fields of medical sciences.

Rating Pakistani medical journals using the principles of citation analysis.

OBJECTIVE: To quantify the impact of Pakistani Medical Journals using the principles of citation analysis. METHODS: References of articles published in 2006 in three selected Pakistani medical journals were collected and examined. The number of citations for each Pakistani medical journal was totalled. The first ranking of journals was based on the total number of citations; second ranking was based on impact factor 2006 and third ranking was based on the 5-year impact factor. Self-citations were excluded in all the three ratings. RESULTS: A total of 9079 citations in 567 articles were examined. Forty-nine separate Pakistani medical journals were cited. The Journal of the Pakistan Medical Association remains on the top in all three rankings, while Journal of College of Physicians and Surgeons-Pakistan attains second position in the ranking based on the total number of citations. The Pakistan Journal of Medical Sciences moves to second position in the ranking based on the impact factor 2006. The Journal of Ayub Medical College, Abbottabad moves to second position in the ranking based on the 5-year impact factor. CONCLUSION: This study examined the citation pattern of Pakistani medical journals. The impact factor, despite its limitations, is a valid indicator of quality for journals.

Synergistic interaction of epinephrine and calcium ionophore in platelet aggregation.

BACKGROUND: Platelets play a key role in haemostasis. Human Platelets contain alpha2 adrenergic receptors, which are coupled with guanine nucleotide proteins (G proteins). The platelet activation involves a number of receptors for agonists. It has also been shown that most of the agonists act in synergy and potentiate the effects of each other. The present experimental study was designed to study the potentiation of epinephrine on human platelets by calcium ionophore A23187 and the possible role of calcium in platelet aggregation as a second messenger. METHODS: Study was carried out at Department of Biological Sciences Aga Khan University, Karachi. Blood samples from healthy volunteers were collected; Platelet aggregation was measured using Dual channel Lumi Aggregometer. The chemicals used include epinephrine, calcium ionophore A23187, yohimbine, diltiazem, verapamil and S Nitrosoacetylpenicillamin (SNAP). RESULTS: Epinephrine at low concentrations (0.01-0.2 microM) and/or A23187 (0.1-0.5 microM) itself did not produce platelet aggregation. However, when added together, a marked potentiation of platelet aggregation was observed. This synergistic effect was inhibited by alpha2-receptor blocker yohimbine; (IC50 = 0.05 microM) showing that the response is receptor mediated. To find out the molecular basis of this potentiation, we used SNAP, a nitric oxide donor and Ca++ channel blockers, i.e. diltiazem and verapamil. The SNAP, diltiazem and verapamil inhibited the platelet aggregation induced by A23187 and epinephrine with IC50 value of 0.5 microM, 50 microM and 22 microM respectively. CONCLUSION: The results of the study suggest that epinephrine and calcium ionophore act synergistically and Ca++ plays an important role in this synergistic interaction. While calcium channels blocking drugs diltiazem and verapamil inhibit this synergism.

Synergistic interaction of adenosine diphosphate-epinephrine and epinephrine-collagen in aggregation of human platelets.

BACKGROUND: Efficient hemostasis in human body depends on a complicated series of events which actively involve blood platelets. Platelets exhibit diverse responses in a variety of agonists. In vivo, most of the agonists act in synergism, causing aggregation of platelets. METHODS: In this study, the synergism between ADP-Epinephrine and Epinephrine-Collagen has been determined by means of turbidometric method, which measures changes in optical density of platelet suspension. The study was carried out at the department of Hematology, Armed Forces Institute of Pathology, Rawalpindi. The subthreshold concentrations of each of the agonists were established with the help of dose response curve. By adding these agonists in subthreshold concentrations, the synergism between ADP-Epinephrine and Epinephrine-Collagen was determined. RESULTS: The combinations of these agonists in subthreshold levels showed the synergistic responses in causing platelet aggregation. CONCLUSION: These findings indicate that the optimal platelet aggregation does occur between the above mentioned pairs of agonists even when each of the agonist is added to the other in subthreshold doses.