chronic liver disease due to hepatitis B infection is a common problem in our country' The
sole method of accurate diagnosis is liver biopsy, which is an invasive technique associated
with complications, and is expensive
Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
Slides From Hot Topics in NASH:New Strategies for the Diagnosis of NASH.2019hivlifeinfo
Slides From Hot Topics in NASH: New Strategies for the Diagnosis of NASH
xpert faculty present key data on current and emerging NASH treatment options for your patients.
Rita Basu, MD
Wing-Kin Syn, MBChB, PhD, FACP, FRCP
Format: Microsoft PowerPoint (.ppt)
File Size: 3.84 MB
Released: February 11, 2019
Statistical analysis of risk factors associated withanamjavaid13
Gallstones are crystal like collections that formed by merging of normal and abnormal gallbladder content. Usually there are two types of gallstones exist i.e. cholesterol stones & pigment stones. The current paper focuses on symptoms of the disease, major cause for the disease and on the treatments that majority of patients preferred. For this purpose, sample of size 170 data from different hospitals in Multan is collected by using convenience sampling. Main demographic factors involved in this study are Gender, Age group, marital status for patients of GSD. Frequency distribution has been formed for these different demographic and social factors and a bar chart is constructed for differentiating between gender as gender is also an important factor in GSD. For weight factor, paired t test is applied to see the difference between before and after weight after having treatment. Findings show that 67 percent people prefer govt. hospitals because of the people suffering from this disease were from backward areas or villages & their income not meet to pay the private hospitals expense.
The study to measure the level of serum annexin V in patients with renal hype...inventionjournals
ABSTRACT : Renovascular hypertension reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular disease and hypertension roughly defines this type of nonessential hypertension. The aim of this study was to measure the level of serum Anti-Annexin V antibodies in patients with renal hypertension. Methods. This study was conducted on 115 patients, diagnosed with renal hypertension and hypertension. Informed consents were obtained from the patients and the study was approved by the Kharkiv National Medical University ethics committee. Ten healthy age and sex matched volunteers were included as a control group. All patients and controls were subjected to the following full history taking and thorough clinical examination. Routine laboratory testing included a complete blood count, and erythrocyte sedimentation rate (ESR) and kidney function tests (blood urea nitrogen and serum creatinine). Immunological tests for antinuclear antibody (ANA) and anticentromere antibodies (ACA) was performed by the indirect immunofluorescence technique. AntiScl-70 (anti-topoisomerase antibodies) and anticardiolipin antibodies (ACA: IgG and IgM) were tested using the ELISA technique. The anti-annexin V antibodies titre used the ZYMUTEST anti-Annexin IgG ELISA kit. [Hyphen-BioMed, France.]: to measure the IgG isotype of auto-antibodies to annexin V in human serum. Results. Anti-annexin V antibodies were present in 75% of patients (mean 83.46 ± 22.44 AU/mL) vs. 0% in the controls (mean 3.94 ± 4.5 AU/mL). Comparison between patients and controls as regards levels of anti-annexin V showed a highly significant difference (P < 0.001). Furthermore, correlation of anti-annexin V titres with the disease activity score in the patient group showed a statistically significant positive correlation (r = 0.51, P < 0.05).In addition, the anti-annexin V antibody titres in this study showed a highly significant positive correlation with ACL antibodies (r = 0.74, P < 0.001). Patients with antiphospholipid syndrome (APS) have been known to have a higher frequency of anti-annexin V antibodies, and thrombotic events have been reported more frequently in patients with positive anti-annexin V antibodies. Furthermore, inhibition of annexin V binding to negatively charged phospholipids may be an additional pathogenic mechanism of APS.
Background: Resectability Criteria for Colorectal Liver Metastases (CRLM) have expanded, and advances in liver surgery have increased the number of patients eligible for resection. Identifying risk factors for early recurrence to help stratify CRLM patients will contribute to targeted management of these patients, including surveillance follow-up.Objectives: To identify risk factors for early recurrence post-resection for CRLM in a contemporary cohort of patients. Early recurrence was defi ned based on unit protocol as evidence of recurrent disease on follow-up imaging within one year of surgery.Methods: From January 2012 to December 2016, 133 patients with CRLM underwent liver resection in our Unit; 115 patients followed up for at least a year were eligible. We analysed pre-operative variables (sex, age, BMI, comorbidities, CEA and Liver function tests (LFTs), lesion number, size of largest liver lesion, neoadjuvant chemotherapy), operative variables (anatomical vs non-anatomical, major vs minor, redo liver surgery, concomitant use of ablation techniques, blood loss, blood transfusions, Pringle’s manoeuvre), and post-operative variables (complications, length of hospital stay, histological parameters) were analysed.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...daranisaha
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesion
Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
Slides From Hot Topics in NASH:New Strategies for the Diagnosis of NASH.2019hivlifeinfo
Slides From Hot Topics in NASH: New Strategies for the Diagnosis of NASH
xpert faculty present key data on current and emerging NASH treatment options for your patients.
Rita Basu, MD
Wing-Kin Syn, MBChB, PhD, FACP, FRCP
Format: Microsoft PowerPoint (.ppt)
File Size: 3.84 MB
Released: February 11, 2019
Statistical analysis of risk factors associated withanamjavaid13
Gallstones are crystal like collections that formed by merging of normal and abnormal gallbladder content. Usually there are two types of gallstones exist i.e. cholesterol stones & pigment stones. The current paper focuses on symptoms of the disease, major cause for the disease and on the treatments that majority of patients preferred. For this purpose, sample of size 170 data from different hospitals in Multan is collected by using convenience sampling. Main demographic factors involved in this study are Gender, Age group, marital status for patients of GSD. Frequency distribution has been formed for these different demographic and social factors and a bar chart is constructed for differentiating between gender as gender is also an important factor in GSD. For weight factor, paired t test is applied to see the difference between before and after weight after having treatment. Findings show that 67 percent people prefer govt. hospitals because of the people suffering from this disease were from backward areas or villages & their income not meet to pay the private hospitals expense.
The study to measure the level of serum annexin V in patients with renal hype...inventionjournals
ABSTRACT : Renovascular hypertension reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular disease and hypertension roughly defines this type of nonessential hypertension. The aim of this study was to measure the level of serum Anti-Annexin V antibodies in patients with renal hypertension. Methods. This study was conducted on 115 patients, diagnosed with renal hypertension and hypertension. Informed consents were obtained from the patients and the study was approved by the Kharkiv National Medical University ethics committee. Ten healthy age and sex matched volunteers were included as a control group. All patients and controls were subjected to the following full history taking and thorough clinical examination. Routine laboratory testing included a complete blood count, and erythrocyte sedimentation rate (ESR) and kidney function tests (blood urea nitrogen and serum creatinine). Immunological tests for antinuclear antibody (ANA) and anticentromere antibodies (ACA) was performed by the indirect immunofluorescence technique. AntiScl-70 (anti-topoisomerase antibodies) and anticardiolipin antibodies (ACA: IgG and IgM) were tested using the ELISA technique. The anti-annexin V antibodies titre used the ZYMUTEST anti-Annexin IgG ELISA kit. [Hyphen-BioMed, France.]: to measure the IgG isotype of auto-antibodies to annexin V in human serum. Results. Anti-annexin V antibodies were present in 75% of patients (mean 83.46 ± 22.44 AU/mL) vs. 0% in the controls (mean 3.94 ± 4.5 AU/mL). Comparison between patients and controls as regards levels of anti-annexin V showed a highly significant difference (P < 0.001). Furthermore, correlation of anti-annexin V titres with the disease activity score in the patient group showed a statistically significant positive correlation (r = 0.51, P < 0.05).In addition, the anti-annexin V antibody titres in this study showed a highly significant positive correlation with ACL antibodies (r = 0.74, P < 0.001). Patients with antiphospholipid syndrome (APS) have been known to have a higher frequency of anti-annexin V antibodies, and thrombotic events have been reported more frequently in patients with positive anti-annexin V antibodies. Furthermore, inhibition of annexin V binding to negatively charged phospholipids may be an additional pathogenic mechanism of APS.
Background: Resectability Criteria for Colorectal Liver Metastases (CRLM) have expanded, and advances in liver surgery have increased the number of patients eligible for resection. Identifying risk factors for early recurrence to help stratify CRLM patients will contribute to targeted management of these patients, including surveillance follow-up.Objectives: To identify risk factors for early recurrence post-resection for CRLM in a contemporary cohort of patients. Early recurrence was defi ned based on unit protocol as evidence of recurrent disease on follow-up imaging within one year of surgery.Methods: From January 2012 to December 2016, 133 patients with CRLM underwent liver resection in our Unit; 115 patients followed up for at least a year were eligible. We analysed pre-operative variables (sex, age, BMI, comorbidities, CEA and Liver function tests (LFTs), lesion number, size of largest liver lesion, neoadjuvant chemotherapy), operative variables (anatomical vs non-anatomical, major vs minor, redo liver surgery, concomitant use of ablation techniques, blood loss, blood transfusions, Pringle’s manoeuvre), and post-operative variables (complications, length of hospital stay, histological parameters) were analysed.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...daranisaha
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesion
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
We evaluated 112 consecutive Caucasian cirrhotic
patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2)
levels. Patients without confirmed HCC at baseline were further
followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as
histological confirmation of HCC was established in patients with
new lesions. During 5-year surveillance, 14 (16.6%) patients developed HCC
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
We evaluated 112 consecutive Caucasian cirrhotic
patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2)
levels. Patients without confirmed HCC at baseline were further
followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as
histological confirmation of HCC was established in patients with
new lesions. During 5-year surveillance, 14 (16.6%) patients developed HCC.
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...JohnJulie1
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions.
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...NainaAnon
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...EditorSara
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...EditorSara
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions
By Dr. Usama Ragab, Zagazig Faculty of Medicine
PSC incidence ranges from 0.5 to 1.25 cases/100 000.
The prevalence of the disease ranges between six and 20 cases/100 000.
Men are more likely to be affected (70%).
Prevalence of PSC may be increased in first degree relatives of PSC patients
Background of study: There is emerging evidence that human immunodeficiency virus (HIV) infection, even in the absence of anti-retroviral therapy (ART) toxicity and other cofactors, may have a direct impact on liver pathogenesis. Aim: Based on this premise, our study determined the impact of HIV infection on liver enzymes as markers of hepatic function. Methods: the case-control study comprised of a total of 60 participants (30 males and 30 females) aged 18-60 years. The study compared aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), cluster of differentiation (CD4+) cells among ART-naïve HIV patients (n=20), follow-up HIV patients who were on highly active ART (n=20) and apparently healthy controls (n=20). Results: a significant (P<0.05) change was observed in the liver enzymes and CD4+ cells among the study groups compared. Specific changes showed that serum AST, ALP levels of ART-naïve patients were significantly (P<0.05) higher than that of follow-up and controls. Serum ALT levels of controls were significantly (P<0.01) lower than that of ART-naïve and follow-up patients. The CD4+ cell count of ART-naïve patients was significantly (P=0.000) lower than that of follow-up and control groups. Conclusion: Liver enzyme abnormalities were observed in ART naïve HIV infected patients. Consequently, there is a need to monitor liver enzyme levels before and after initiation of therapy.
Similar to Efficacy of AST/ALT Ratio for Assessment of Liver Fibrosis in chronic Hepatitis B lnfection (20)
serum Bilirubin and some Hematological parameters in Patients with Presenile ...MatiaAhmed
Cataract is the leading cause of reversible blindness and visual impairment.
It may be associated with G6PD deficiency and can produce hemotytic manifestations.
Eosinophils and Eosinophil Products in Bronchial AsthmaMatiaAhmed
Eosinophits are known to be an indirect marker of airway inflammation in asthma. tt is
known since long that the total eosinophil count reflects asthmatic activity and is useful for
regulating steroid dosage and for early detection of exacerbations.
Wife baftering is known all over the world among all state of the society. lt is an impact in the
civilized progressive society of the Western world as in the society of ours.
Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic P...MatiaAhmed
Asthma affects more than 100 million people worldwide. lncreased morbidrty
include increased exposure to indoor allergens and environmental pollutants
agonist, under-use of anti-inflammatory mediators and limited education about healu' care
Knowledge and Perception on Noncommunicable diseases (NCDs) among Health Prof...MatiaAhmed
The rapid rise of Noncommunicable diseases represents one of the major
health challenges to global development in the 21st century. Among the 20 Grand
Challenges in Chronic NCDs the priority focuses of area is to explore the level of knowledge
and perception among health professionals and its determinants
Comparative Study of Serum Electrolytes among Treated Diabetic SubjectsMatiaAhmed
This study was designed to investigate the measurements of serum levels of Na+
, K+
, Mg2+
and Ca2+ and their changes with serum glucose levels. Thirty treated diabetic patients (diet
/ OHA), aged between 23 to 27 years and having BMI of 17.9 to 22.54 kg/m2
were selected
randomly from the outpatient department of BIRDEM.
A Gase of Road Traffic Accident in the Perspective of Forensic MedicineMatiaAhmed
A young male of 28 yrs was involved with road traffic accident while crosslng road. The
victim expired on the spot. Police sub inspector from shabag thana made the inquest
report & brought the dead body to the Dhaka Medical College morgue. Post mortem
examination was done.
Faculty Development Strategy is An Essential Element for Quality TeachingMatiaAhmed
Faculty Development Strategy is An Essential Element
for Quality Teaching
Quality teacher is an essential commodity for production of quality graduates, and quality
graduates contribute to health standard of a community as such of a country.
Lesson Plan
Basics and Principles
Lesson Planning is a large part of being organized and a key feature of a competent
teacher. It is a special skill that is learnt in much the same way as other skills. Careful
lesson planning can help to ensure the successful running of courses. Incorporating best
practices in teaching and learning into the design process will help students to meet their
learning objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Efficacy of AST/ALT Ratio for Assessment of Liver Fibrosis in chronic Hepatitis B lnfection
1.
2. Original Article
Efficacy of Asr/ALT Ratio for Assessment of Liver
Fibrosis in chronic Hepatitis B lnfection
Eram Mustafizl, Ruksana Kariml, Tasmina Parveen2, Matia Ahmed2' Md Shahadat Hossain3
Abstract
chronic liver disease due to hepatitis B infection is a common problem in our country' The
sole method of accurate diagnosis is liver biopsy, which is an invasive technique associated
with complications, and is ixpensive. The main aim of the current study is to evaluate the
efficacy of indirect serum markers for diagnosis of severity and extent of fibrosis in patients
with chronic hepatitis B. This is a cross-sectional study on sertlm aspartate aminotransferase
- serum alanine aminotransferase ratio (AST/ALT ratio) in patients with liver fibrosis following
chronic Hepatitis B infection. The study was done on a total of 50 biopsy-diagnosed'
treatment-naive Hepatitis B patients. serum AST and ALT were estimated by Kinetic UV
method. Fibrosis was scoied according to the scheuer scheme. Data were analyzed
statisticalty by spearman's rank correlation usrng sPSS softvvare version 12' Mean AST/
ALT ratio was found to be 0.92 x 0.28. AST/ALT ratio shows almost no correlation with mild
or significant fibrosis by spearman's rank correlation coefficient (r = 0'118; p >0'1)' lt can
thus be concluded from'this study that AST/ALT ratio has low diagnostic accuracy for
predicting significant fibrosis and cirrhosis in individuals with chronic hepatitis B infection'
Keywords: AST/ALT ratio, Liver fibrosis, Chronic hepatitis
(J tJttara Adhunik Med Colt' 2011; 1(2) : 52-55)'
lntroduction
Liver fibrosis is not an independent disease but
rather a scarring response that results f rom chronic
injury of any cause, including hepatitis B and C'
excessive alcohol ingestion, nonalcoholic
steatohepatitis (NASH), and iron overload' Chronic
viral hepatitis B and C are the most common causes
of liverfibrosisl.
Liver biopsy is the gold standard method to assess
liver fibrosis in patients with chronic liver disease' lt
plays a prominent role in the management of chronic
hepatitis B (CHB), which is helpful in confirming
diagnosis, identifying other causes of liver disease'
as well as assessing grade of inflammation and stage
of fibrosis. Results of liver biopsy also assist in guiding
1 . Department of Biochemistry, Uttara Adhunik Medical College'
Dhaka 1 230, Bangladesh,
2. Department of Physiology' Uttara Adhunik Medical College'
Dhaka 1 230, Bangladesh,
3. Department of Biochemistry, MAG Osmani Medical College'
Sylhet 3100, Bangladesh.
aOdress of Correspondence: Dr' Eram Mustafiz' Assistant
Professor, Department of Biochemistry, Uttara Adhunik Medical
College, Sonargaon Jonopath, Plot # 34, Road # 4' Sector # 9'
Uttara Model Town, Dhaka 1230, Bangladesh'
treatment strategy in patients with chronic hepatitis
B2-3.
However, liver biopsy is an invasive procedure
associated with major complications and expensive
as well. As a result, simple and reliable non-invasive
markers such as blood tests and/or liver imaging
modalities that accurately correlate with disease
activity and stage are urgently needed to assist in
the management of chronic hepatitis B patients
worldwideind so reduce the need for repeated liver
biopsiesa-6.
Many models involving routine lab^oi3to-rylests'
e'g''
,.prrtrt" aminotraniferase (AST), ALT (alanine
aminotransferase), platelet count, gamma-
glutamyltransferase (GGT), cholesterol' AST/ALT
iatio, APRI etc. are being evaluated for predicting the
different stages of liver fibrosis' The present study
involves the assessment of liver fibrosis using a model
involving a combination of routine laboratory tests'
namely serum aspadate aminotransferase-alanine
aminotransferase ratio (AST/ALTratio)' The main aim
of the current study is to assess the eff icacy of serum
AST/ALT ratio for diagnosis of severity and extent of
fibrosis in patients with chronic hepatitis B'
3. Efficacy of AST/ALT Ratio for Assessment of Liver Fibrosis in Chronic Hepatitis B lnfection Eram Mustafiz et al
significance. Data were analyzed statistically by
Spearman's rank correlation coefficient using SPSS
software version 12.
Results
The age range of the 50 patients was 15-47 years and
the mean age was 27.4 + 8.03. Males and females
were 37 (74'/") and 13 (26%) respectively. The mean
AST/ALT ratio was 0.92 t 0.28, the values ranging
f rom 0.41 lo 2.02. The values of AST/ALT ratio did not
show a linear relationship with increasing fibrosis stage
(Table 1 and Figure 1).
Table-l
AST/ALT ratio in relation to different stages
of fibrosis
Fibrosis stage No. (%) of patients AST/ALT
ratio (Mean + SD)
2 (4)
22 (44)
4 (8)
13 (26)
e (18)
50 (1oo) 0.92 x. O.28
01234
Stages of fibrosis
Fig.-l: Bar diagram of mean AST/ALT ratio in relation
to the stages of fibrosis.
Materials and Methods
A cross sectional study was designed in the
Department of Biochemistry, Dhaka Medical College,
Dhaka from July 2006 to June 2007. The study was
done on a total of 50 patients with chronic hepatitis B
who were admitted in the Depaftment of Hepatology,
Bangabandhu Sheikh Mujib Medical University
(BSMMU), and Department of Gastroenterology,
Dhaka MedicalCollege and Hospital (DMCH), Dhaka.
All patients were treatment-naive, had hepatitis B virus
surface antigen (HBsAg) positive for more than 6
months and hepatitis B virus (HBV) DNA level
>105copies/ml prior to entry into the trials with no
evidence of decom pensation, metabol ic abnorm alities,
associated co-infection, pregnancy or any other
disease that may alter the serum AST and ALT levels.
Only pre-treatment biopsies were used forthe current
study. Every patient was diagnosed clinically and
histopathologically. Fibrosis was scored according to
the Scheuer Scheme. According to the Scheuer
scheme, the stage F0 indicates no fibrosis, F1
indicates fibrous podal expansion, F2 indicates portal-
pofial septa, F3 indicates bridging with distotlion, and
F4 indicates cirrhosisT-8.
The study protocol was approved, permission was
taken from the concerned departments and authorities,
and ethical clearance was given by the Ethical
Committee, Dhaka Medical College and Hospital
(DMCH), Dhaka. Allthe patients gave informed written
consent on entry to the trials for use of these data for
research purposes. A preset data form was filled for
every subject.
Five millilitre of venous blood was drawn from each
subject under aseptic condition and centrifuged for
obtaining serum. Serum ALT and AST concentrations
were estimated by Kinetic UV method, and ASTiALT
ratio was calculated as follows:
AST/ALT ratio = Serum AST level (U/l)/Serum ALT
level(U/l)
Upper limit of normal range was taken as 45 U/ lor
AST and 40 UA for ALT. Values were expressed as
mean l SD (standard deviation) unless otherwise
stated. Relationships among different variables were
established by linear correlation (correlation coefficient
or 'r'). p value of <0.05 was taken as the level of
0
1
2
3
4
0.69 t 0.36
0.90 t 0.23
0.84 t Q.22
.1.03
t 0.35
0.90 t 0 25
1.20
1.00
0.00
53
4. J Uttara Adhunik Med. College Vol.01 , No.02, July 2011
Table-ll
AST/ALT ratio in retation to severity of fibrosis and Spearman's rank correlation between them
Fibrosis No. (%) of subjects AST/ALT rvalue pvalue
< Stage 2(mild to moderate fibrosis)
>Stage 2(signif icant fibrosis and cirrhosis)
28(56"/")
12(44%)
0.87 10.24
0.97 r0.32
0.034 0.865(>0.05)
0.17s 0.436(>0.05)
Table-lll shows fibrosis to have a weak positive correlation with AST/ALT ratio by Spearman's rank (rio) conelation
coefficient (r).
Table-lll
Spearman's rank correlation of serum AST/ALT ratio with stage of fibrosis
Parameter (Mean t SD) r value pvalue
Stages of Fibrosis AST/ALT ratio 0.92 t 0.28 0.118 0.414 (>0.05)"
.Correlation is not significant
Receiver operating characteristics (HOC) curves were
plotted and the area underthe ROC (AUROC) curyes
were determined to detect the ability of AST/ALT ratio
to predict the different stages of hepatic fibrosis. An
AUC of 1.0 is characteristic o{ an idealtest, whereas
an AUC of 0.5 or less indicates a test of no diagnostic
value.
The AUROC for AST/ALT ratio was al0.47 in mild
fibrosis, 0.41 in moderate fibrosis, 0.63 in significant
fibrosis, and 0.49 in cirrhosis. The AUROC curves of
AST/ALI- ratio were not significant and so were not
evaluated fudher.
Discussion
The ideal non-invasive diagnostic test for hepatic fibrosis
is one that is simple, readily available, inexpensive,
and accurate. Many models based on non-invasive
determinations have been developed for liverfibrosis in
chronic hepatitis C infection and some of them have
been tested in chronic hepatitis B as well, but their
clinical usefulness is still controversial. Liver biopsy is
still the gold standard for assessment of fibrosis.
The present study involves the assessment of liver
fibrosis using a model involving a combination of
routine laboratory tests like AST/ALT ratio. lt has been
previously applied in similar studies but the results
concerning its diagnostic powers were often
conflicting. The results of the current study showed
that the AST/ALT ratio is not significantly associated
with the extent of liver fibrosis in chronic hepatitis B.
The mean AST/ALT ratio in the current study was 0.92
t 0.28. AST/ALT ratio did not show linear relationship
with fibrosis stages. lt was more than 0.8 in all stages
of f ibrosis and no def inite differentiating level of AST/
ALT ratio could be identified in predicting advanced
fibrosis. lt showed almost no correlation with mild or
significant f ibrosis (r = 0.'118; p >0.1). The area under
the ROC curves of AST/ALTratiofor predicting different
stages of fibrosis were insignifrcant and so was not
evaluated further. The AUROC ranging f rom 0.41 to
0.63 was consistent with the findings repofted by Wai
et at.e where AUROC was at 0.58-0.63, and by
Lackner et a/.4 that AST/ALT ratio has low diagnostic
accuracy for predicting advanced fibrosis. According
to Fontana and Lok10, available serum iibrosis marker
panels cannot reliably distinguish between individual
stages of fibrosis but rather provide a binary
categorization of disease severity.
Serum ALT levels ref lect liver injury, but the correlation
between ALT levels and necroinflammatory and {ibrosis
scores is poor10. Despite the poor quantitative
correlation, most patients with persistently normalALT
levels (at least 3 normal values over a 6 to 12 month
period)have less inflammation and fibrosis, and slower
rate of fibrosis progression compared with patients
with elevated AST levels. One study found that AST
had a slronger correlation with liver histology, in
particular hepatic f ibrosis 11
.
Reversal of AST/ALT ratio was observed when patients'
progress from chronic hepatitis to cirrhosis and AST/
ALT ratio of more than t had been reported to have
very high specificity (82%to 100%)for cirrhosisl2-14.
Further studies should be done to evaluate the efficacy
of ALT/AST ratio as a marker of lrver fibrosis.
a
5. F
=1 cacy of AST/ALT Ratio for Assessment of Liver Fibrosis in Chronic Hepatitis B lnfection
-^e f inding of increased AST level with progression of
. er fibrosis has been reported in many studies. While
:ST had been persistenily found to be useful in
c'edicting significant fibrosis in patients with chronic
:epatitis B (CHB), it is not an independent factor in
credicting either significant fibrosis or cirrhosis in
catients with CHBe,15-17. El"rrtion of AST with
progression of liver fibrosis was believed to be due to
reduction in the clearance of AST18 and mitochondrial
injury with more marked release of AST relative to
ALT in CHCIe-20.
There are limitations to the study. The study included
patients from a university hepatology ward and allthe
patients were treatment-naTve. All the patients had
HBV DNA >105 copies/ml and so these models are
not applicable for those with inactive virological disease
(HBV DNA <10s copies/ml). Due to f und constraints,
other models with higher degrees of accuracy could
not be compared with the models in this study.
Conclusion
It can thus be concluded from this study that AST/
ALT ratio which was unable to differentiate between
the individual stages of fibrosis, has low diagnostic
accuracy for predicting significant fibrosis and cirrhosis
in individuals with chronic hepatitis B infection.
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