Assessment of pro-inflammatory cytokines in sera of patients with hepatitis C virus infection before and after anti-viral therapy.

INTRODUCTION: A number of cytokines have been implicated in hepatitis C virus (HCV)-related liver disease. This study aimed to assess the serum levels of pro-inflammatory cytokines in patients with HCV infection before (naïve) and after successful treatment (sustained responders) with Pegylated interferon and ribavirin. METHODOLOGY: The present study included 19 naïve HCV patients and 8 sustained responders. Additionally, 20 healthy individuals were included as a control group. The serum levels of the pro-inflammatory cytokines interleukin-8 (IL-8), IL-6, IL-10, IL-1ß, and IL-12p70 were measured using flow cytometry. RESULTS: The serum IL-8 levels were significantly higher in the naïve group (21.5±10.7 pg/mL; p=0.02) than in the control group (14.1±1.7 pg/mL) and the sustained responder group (10.4±6.2 pg/mL; p=0.002). The serum IL-6 levels were significantly higher in the naïve group (7.3±2.06 pg/mL; p=0.02) than in the control group (5.9±1.01 pg/mL) whereas IL-6 in sustained responder group (6.4±1.5 pg/mL) was no different than naïve HCV patients or the controls. The serum IL-10 levels were significantly higher in the naïve group (4.42±0.64 pg/mL) than in the control group (3.6±0.34 pg/mL; p=0.0002) and not the sustained responder group (4.1±0.86 pg/mL). Moreover, the serum IL-12p70 levels were higher in the sustained responder group (3.43±0.84 pg/mL; p=0.05) than in the control group (2.76±0.83 pg/mL). There were no differences in the serum IL-1ß levels among the groups. CONCLUSION: Successful anti-viral therapy against HCV was associated with significant reductions in the serum IL-8 levels and skewing of the pretreatment Th2 dominant immune response to the Th1 response.

Patient safety culture in a large teaching hospital in Riyadh: baseline assessment, comparative analysis and opportunities for improvement.

BACKGROUND: In light of the immense attention given to patient safety, this paper details the findings of a baseline assessment of the patient safety culture in a large hospital in Riyadh and compares results with regional and international studies that utilized the Hospital Survey on Patient Safety Culture. This study also aims to explore the association between patient safety culture predictors and outcomes, considering respondent characteristics and facility size. METHODS: This cross sectional study adopted a customized version of the HSOPSC and targeted hospital staff fitting sampling criteria (physicians, nurses, clinical and non-clinical staff, pharmacy and laboratory staff, dietary and radiology staff, supervisors, and hospital managers). RESULTS: 3000 questionnaires were sent and 2572 were returned (response rate of 85.7%). Areas of strength were Organizational Learning and Continuous Improvement and Teamwork within units whereas areas requiring improvement were hospital non-punitive response to error, staffing, and Communication Openness. The comparative analysis noted several areas requiring improvement when results on survey composites were compared with results from Lebanon, and the United States. Regression analysis showed associations between higher patient safety aggregate score and greater age (46 years and above), longer work experience, having a Baccalaureate degree, and being a physician or other health professional. CONCLUSIONS: Patient safety practices are crucial toward improving overall performance and quality of services in healthcare organizations. Much can be done in the sampled organizations and in the context of KSA in general to improve areas of weakness and further enhance areas of strength.

Assessment of alpha-fetoprotein in the diagnosis of hepatocellular carcinoma in Middle Eastern patients.

BACKGROUND: Alpha-fetoprotein (AFP) levels for the diagnosis of hepatocellular carcinoma (HCC) may vary by geographical region and racial background. No data exists for this test in the Middle Eastern population. In addition, there is limited data on the impact of virological status on AFP levels. METHODS: In a multicenter, case-control study involving 206 cases, 199 cirrhotic and 197 chronic hepatitis controls, we assessed the utility of AFP in the diagnosis of HCC (sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and positive likelihood ratios (LR). PPV and NPV were evaluated for three additional HCC prevalence rates (5, 10, and 20%). RESULTS: The best discriminating AFP value was 11.7 ng/ml. The sensitivity ranged from 32 to 79.5% at different AFP levels with the specificity increasing sequentially from 47.7 to 98.5%. Sensitivity of AFP at the best cut-off level for hepatitis C virus (HCV), hepatitis B virus (HBV) and non-viral etiology for HCC was 73.7, 65.6, and 59.5%, respectively. Specificity at this level for HCV, HBV, and non-viral etiology was 36.6, 30.1, and 29.4%, respectively. AFP cut-off levels of 102, 200, and 400 ng/ml showed similar sensitivity (39.8, 35.9, and 32%, respectively) and specificity (96, 98.5, and 98.5% respectively). Positive LR for AFP at >11.7, >20, >102, >200, >400 ng/ml were 2.8, 3.3, 9.9, 23.8, and 21.2, respectively. CONCLUSIONS: In cirrhotic patients, AFP has a poor screening and diagnostic value for HCC. Underlying viral etiology fails to influence the diagnostic accuracy of this test. An AFP level greater than 100 ng/ml has a high degree of specificity and may be used as a confirmatory test.