This document summarizes a case of primary biliary cirrhosis (PBC) in a 66-year-old man who presented with intermittent pruritus for 8 years. Laboratory tests showed elevated liver enzymes and positive anti-mitochondrial antibodies, confirming the diagnosis of PBC. Liver biopsy showed features characteristic of PBC including destruction of bile duct epithelium and lymphocyte infiltration. The document then provides information on the epidemiology, risk factors, pathogenesis, natural history, diagnosis, treatment and prognosis of PBC.
download link : https://www.dropbox.com/s/xc0fpdul47g1gu8/IgA%20Nephropathy.ppt?m
Join us on our facebook group: NephroTube...............Follow our blog: www.nephrotube.blogspot.com
This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
inflammatory bowel disease is a diagnosis of exclusion and it has two form known as crohn's disease which can affect all GI tract from ''gum to bum'' with skip lesion and the formation of cobblestones. ulcerative colitis affect only the colon and also causes proctitis and toxic megacolon. both of the disease has extraGI symptoms like sclerosing cholangitis, uveitis, ankylosing spondylitis,conjunctivitis, liver cirrhosis, pyoderma gangrenosum, arthropathy and althralgia, etc .
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
download link : https://www.dropbox.com/s/xc0fpdul47g1gu8/IgA%20Nephropathy.ppt?m
Join us on our facebook group: NephroTube...............Follow our blog: www.nephrotube.blogspot.com
This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
inflammatory bowel disease is a diagnosis of exclusion and it has two form known as crohn's disease which can affect all GI tract from ''gum to bum'' with skip lesion and the formation of cobblestones. ulcerative colitis affect only the colon and also causes proctitis and toxic megacolon. both of the disease has extraGI symptoms like sclerosing cholangitis, uveitis, ankylosing spondylitis,conjunctivitis, liver cirrhosis, pyoderma gangrenosum, arthropathy and althralgia, etc .
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
Beyond LFT - A Radiologist’s Guide to the Liver Blood TestsAbhineet Dey
Abnormal liver blood test results are often the first indicator of hepatobiliary disease and a common indication for abdominal imaging with US, CT, or MRI.
Most of the disease entities can be categorized into hepatocellular or cholestatic patterns, with characteristic traits on liver blood tests. Each pattern has a specific differential, which can help narrow the differential diagnosis when combined with the clinical history and imaging findings.
Overall, integrating liver blood test patterns with imaging findings can help the radiologist accurately diagnose hepatobiliary disease, especially in cases where imaging findings may not allow differentiation between different entities.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
2. Case presentation
A 66-year-old gentleman suffered from intermittent pruritus
for 8 years. But no yellowish discoloration of skin nor tea-
colored urine was complained in that period.
He denied any history of blood transfusion, acupuncture,
tattoo, herbal medicine, smoking or alcohol drinking.
He took a physical check up in September 2005.
Serum biochemistry tests showed ALT level 86 U/L
(normal, 0-40 U/L), AST level 92 U/L (normal, 5-45 U/L),
Alk-P level 229 U/L (normal, 10-100 U/L), total bilirubin 0.9
mg/dL (normal, 0.2-1.6 mg/dL), GGT 630 U/L (normal, 8-
61 U/L), albumin 4.5 gm/dL (normal, 3.7-5.3 gm/dL), IgG
2270 mg/dL (normal, 1188-1800 mg/dL), IgA 309 mg/dL
(normal, 158-358 mg/dL) and IgM 138 mg/dL (normal, 72-
216 mg/dL).
2
3. Case presentation
The serologic tests for HBsAg, anti-HBs, and anti-HCV
were all negative. But antibody against hepatitis B core
antigen (anti-HBc) was positive, indicating a previous or
occult HBV infection. Serum HBV DNA was negative by
polymerase chain reaction (PCR) method.
Serum autoantibodies including anti-nuclear antibody and
anti-smooth muscle antibody were negative, but anti-
mitochondrial antibody (Fluoro-kit; Incstar, Stillwater, MN)
was positive.
3
4. Liver Biopsy
H&E stain, x 800 Masson, x 1600
focal destruction of bile duct epithelium with lymphocytes infiltration,
focal absence of bile duct combined with periportal fibrosis and necrosis
6. 66
Epidemiology
Incidence: 0.7 to 49 per million per year
Point prevalence: 6.7 to 402 per million
Highest in Northern European countries & Northern US
Increase incidence and prevalence of PBC worldwide
exposure to environmental factors↑, elderly population↑,
survival↑, earlier diagnosis, improved care, earlier
awareness…
Selmi C, Bowlus CL, Gershwin MR, Coppel RL. Lancet 2011;377:1600-9
7. Risk factors
Smoking, 1.67X Family history, 7.56X
UTI, 2.02XThyroid disease, 3.08X
Liang Y, et al. Hepatology Research 2011;41:572-8
8. Etiologies
• familial clustering
• prevalence: 100x in
first-degree relatives
MHC class II
Innate immunity
adaptative immunity
adaptative immunity
disturbances of host
resistance to infection
and the inflammatory
process
xenobiotics
E.coli, Novosphingobium
aromaticivorans
Generate a transient or chronic
immune response that is cross-
reactive with self PDC:
Molecular mimicry
• M:F=1:10
• defects in the X
chromosome↑
Selmi C, Bowlus CL, Gershwin MR, Coppel RL. Lancet 2011;377:1600-9
10. Cirrhosis with decrease of small bile ductsIncrease in connective tissue (bridging fibrosis)
Bile duct proliferation, inflammatory
infiltrate the periportal field (portal inflammation)
Primary biliary cirrhosis (PBC)
Histology
(H.E., 100x)
Stage I Stage II
Stage IVStage III
Bile duct destruction, inflammation (periportal fibrosis)
Prof. Dr. U. Leuschner
Interdisziplinäres Facharztzentrum, Frankfurt/Main (Germany)
11. Natural History
PBC progresses through three irreversible states: (a)
cirrhosis; (b) a terminal phase defined when serum
bilirubin reaches 6 mg/dL with or without GI bleeding,
ascites, or encephalopathy; and (c) death
Pre-UDCA era
Serum bilirubin increase preceding death
UDCA era
UDCA therapy delay rate of histological progression to
cirrhosis
13–15 mg/kg UDCA daily
Start to treat in early stage good prognosis
12. Long-term survival rates are comparable between
PBC patients and general population
Floreani A, et al. Liver Int 2011;31:361-8
13. Symptoms and Signs
50% patients: asymptomatic at diagnosis
Early phase: fatigue (78%), pruritus (20-70%), osteopenia (33%),
and osteoporosis (11%)
Hypercholesterolemia: typically caused by a rise in HDL, not
increases cardiovascular risk.
All forms of PBC: IgM↑
Typical: ALK-P & GGT↑↑, ALT/AST↑
PBC with AIH features: ALT/AST↑↑, IgG↑↑
Late phase: thrombocytopenia, polyclonal hyperglobulinemia,
and hyperbilirubinemia, hypoalbuminemia
Selmi C, Bowlus CL, Gershwin MR, Coppel RL. Lancet 2011;377:1600-9
14. Diagnosis Criteria
Diagnosis of PBC: two of the three criteria are met
Abnormal biochemical tests with elevation of ALK-P and
GGT
Presence of AMA with M2 specificity
Evidence of non-suppurative destructive cholangitis
(NSDC) at histology
15. Special Cases
AMA-negative PBC
Nearly all of the patients: ANA (+) and/or ASMA (+)
Require liver biopsy
No different prognosis to UDCA Tx compared with AMA(+)
group
16. Comparison of demographic and clinical characteristics at
diagnosis between AMA-positive and AMA-negative PBC patients
AMA(+) (85, 84%) AMA(-) (16, 16%) p
Sex (M/F) 19/66 4/12 NS
Age of diagnosis (mean ± SD; year) 51.2 ± 12.3 52.5 ± 14.8 NS
Symptoms at diagnosis (yes/no) 75/10 14/2 NS
ANA (positive/negative) 52/28 13/3 NS
Albumin (mean ± SD; gm/dL) 3.99 ± 0.53 3.99 ± 0.55 NS
ALT (mean ± SD; U/L) 118.1 ± 88.3 165.8 ± 87.8 NS
Bilirubin (mean ± SD; mg/dL) 2.14 ± 2.03 2.79 ± 2.39 NS
ALK-P (mean ± SD; U/L) 404.0 ± 222.2 535.9 ± 286.4 0.042
Cholesterol (mean ± SD; mg/dL) 261.6 ± 128.6 371.1 ± 173.3 0.005
Child-Pugh (A/B/C) 62/19/4 9/6/1 NS
Mayo score 5.58 ± 1.66 5.61 ± 1.86 NS
Stage of liver histology (1/2/3/4) 7/22/4/5 3/5/1/2 NS
Su CW, Hung HH, Huo TI, Wu JC, et al. Liver Int 2008;28:1305-13
17. Treatment
All PBC patients with abnormal liver biochemistry
should be considered for specific therapy
UDCA
13–15 mg/kg daily
Improves parameters of liver biochemistry
Delays the progression of fibrosis and histological stage
The survival rate of UDCA-treated patients in early
stages of disease is similar to that in a control
population
Adverse effect: gastric discomfort, weight gain, increase
pruritis
18. Treatment
Adjuvant therapies
Patients: features of AIH, severe interface hepatitis, abnormal
serum bilirubin level, poor response to UDCA
Glucocorticoids + UDCA
Methotrexate + UDCA: benefit in a small subset of patients
Cyclosporine monotherapy: prolonged the time to death or
transplantation; high rate of side effects
Colchicine, chlorambucil, penicillamine, azathioprine,
malotilate, and thalidomide ineffective or toxic
19. Factors associated with poor overall
survival in PBC patients in Taiwan
Su CW, Hung HH, Huo TI, Wu JC, et al. Liver Int 2008;28:1305-13
Variable Risk ratio 95% Confidence interval Standard error p
UDCA treatment 0.302 0.125-0.728 0.449 0.008
Albumin≧ 4.0 g/dL 0.321 0.123-0.839 0.491 0.021
Creatinine > 0.8 mg/dL 2.539 1.076-5.994 0.438 0.033
20. Non-invasive serum markers for predicting
hepatic fibrosis in patients with PBC
AUROC 95% CI Standard error P
AAR 0.847 0.727-0.966 0.061 0.001
Mayo PBC risk score 0.722 0.535-0.909 0.095 0.028
MELD score 0.617 0.392-0.842 0.115 0.247
Child score 0.608 0.393-0.823 0.110 0.285
Su CW, Chan CC, Hung HH, Wu JC, et al. J Clin Gastroenterol 2009;43:876-83
21. The application of AAR for predicting
clinical adverse outcomes in patients
with primary biliary cirrhosis
Su CW, Chan CC, Hung HH, Wu JC, et al. J Clin Gastroenterol 2009;43:876-83
22. Greatly improved the survival
Decompensated cirrhosis or liver failure: the only
effective Tx
Premature ductopenic variant
Recurrence
20% of patients at 5 years
more frequent in patients w/o a glucocorticoid and
cyclosporine regimen
Liver transplantation for PBC
23. Liver transplantation for PBC in Taiwan
From 1984 to 2008, 539 primary liver transplantations
were performed in Chang Gung memorial Hospital-
Kaohsiung Medical center, including 19 (3.5%) for PBC.
Liver function returned to normal one month after
transplantation.
The overall 1-,3-, and 5-yr survival rates were 94.7%,
89.2%, and 89.2%, respectively
Variable LDLD (n=14) DDLD (n=5)
Mean age (yr) 51.0 ± 1.5 47.3 ± 3.9
M/F 1/13 1/4
MELD 20.7± 2.4 16.4± 2.4
CTP 11± 0.5 11± 1.1
Sun CK, Chen CL, et al. Clin Transplant 2011;25:47-53
25. Clinical characteristics
Prevalence : 50-200 case/1 million in Western
Europe & North American
Presentation – heterogeneous
Variable – no symptoms/signs to fulminant
hepatic failure
Malaise, anorexia, nausea, vomiting,
abdominal pain, itching
Arthralgia in small joint, hepatomegaly,
splenomegaly
Jaundice
26. Clinical characteristics
Chronic, unknown cause, in all age
Fluctuating course
Laboratory abnormalities
ALT or AST more striking than ALK-P, T bili
γ-globulins, IgG, 1.2~3.0 X
29. Simplified diagnostic criteria (2008) of the international
autoimmune hepatitis group
Points
Autoantibodies ANA or SMA or LKM > 1:40 1
ANA or SMA or LKM > 1: 80
SLA/LP positive (> 20 unit)
2
IgG (or gamma-globulin) Upper normal limit 1
> 1.10 times normal limit 2
Liver histology Compatible with AIH
Chronic hepatitis with lymphocytic infiltration without
features considered typical
1
Typical for AIH
(1) Interface hepatitis:
lymphocytic/lymphoplasmacytic infiltrates in
portal tracts and extending in the lobule
(2) Emperipolesis: active penetration by one cell into
and through larger cell
(3) Hepatic rosette formation
2
Absence of viral hepatitis Yes 2
No 0
29
Hennes EM, et al. Hepatology 2008;48:169-76
Definite AIH ≧7
Probable AIH ≧6
30. Histology of AIH
Interface hepatitis / zone 3 Plasma cell infiltration
Czaja et al, Hepatology, 2002;36:479-497
31. Management algorithm for patients with definite AIH
Lohse AW, Mieli-Vergani G. Autoimmune hepatitis J Hepatol 2011;55:171-82
32. Management for relapse of AIH
29.9% AIH patients suffered from relapses during tapering
of corticosteroid therapy
Yokokawa J, et al. Hepatol Res 2011;41:641-6
OR 95% CI P
Age at diagnosis (≧50 yr) 0.29 0.10-0.86 0.03
Bilirubin (≧1.5mg/dL) 4.50 1.23-16.45 0.02
AST (≧250 IU/L) 4.88 1.35-17.65 0.02
ALT (≧250 IU/L) 10.0 2.56-39.11 <0.01
Prothrombin activity (≧80%) 0.21 0.06-0.80 0.02
Gamma-globulin (≧3.4 mg/dL) 7.20 1.52-34.02 0.01
IgG (≧3400 mg/dL) 2.68 0.88-8.13 0.08
IAIHG score (≧17) 5.54 1.56-19.75 <0.01
33. Management for relapse of AIH
Relapse
(n= 20)
With AZP
(n= 7)
Repeated
relapse
(n=0)
Sustained
remission
(n=7)
No AZP
(n= 13)
Repeated
relapse
(n=8)
Sustained
remission
(n=5)
Azathioprine (AZP) 50-100mg/day
Yokokawa J, et al. Hepatol Res 2011;41:641-6
34. Poor prognostic factors of AIH
Cirrhosis at diagnosis
Development of cirrhosis during treatment
Nonwhite ethnicity
Female sex
Presence of symptoms
Severe liver dysfunction
Less than 10-fold elevation of ALT levels at presentation
Failure to normalize ALT levels with treatment
Recurrent relapses Feld JJ, et al. Hepatology 2005;42:53-62
Verma S, et al. Hepatology 2007;46:1828-35
Montano-Loza AJ, et al. Am J Gastroenterol 2007;102:1005-12
Al-Chalabi T, et al. Clin Gastroenterol Hepatol 2008;6:1389-95
35. Long –term outcomes of patients with AIH
Hoeroldt B, et al. Gastroenterology 2011;140:1980-9
Hazard ratio 95% confidence
interval
P
Decompensation at
presentation
3.92 2.40-6.38 <0.001
Failure to normalize serum
ALT levels within 12
months of treatment
4.27 2.05-8.89 <0.001
No. of relapses per decade 1.12 1.01-1.25 <0.001
Nontreatment with
azathioprine
2.71 1.59-4.60 0.001
Age at presentation (y) 1.05 1.03-1.07 <0.001
36. AIH in Japan
Migita K, et al. Liver Int 2012;32:837-44
Mean age at presentation: 56.6 years
Cirrhosis at presentation: 10.9%
Mean prednisolone dose: 28.71 mg/day
Mean follow-up: 8.0 years
Cirrhosis: 7.8%; HCC: 3.6%
40. AIH in children in Taiwan
Yeh SH, Ni YH, Chang MH, et al. Pediatr Neonatol 2009;50:65-9
Incidence of AIH among children hospitalized with hepatitis: 2.3%
41. Take Home Message
PBC is a chronic inflammatory autoimmune disease that
mainly targets the cholangiocytes of the interlobular bile
ducts in the liver.
When administered at doses of 13-15 mg/kg/day of UDCA
therapy, a majority of patients with PBC have a normal life
expectancy.
AIH is diagnosed based on elevation of IgG, demonstration
of characteristics autoantibodies, and histological features
of hepatitis in the absence of viral disease.
Adequately dosed steroids are the mainstay of remission
induction treatment, while remission maintenance may
need azathioprine in some patients.
AIH patients in Taiwan have comparable therapeutic effects
to steroid in a lower doses.
Australia: cumulative incidence that is almost 10-fold higherincreased exposure to an environmental factor, demographic changes with an increasedelderly at-risk population, increase survival of already diagnosedpersons, earlier diagnosis, improved care, and increase clinicianas well patient awareness, among other reasons.
Figure 4. Properties of Apoptosis in Somatic Cells and Biliary Epithelial Cells.In biliary epithelial cells, the pyruvate dehydrogenase E2 complex (PDC-E2), which is the dominant autoantigen, remainsimmunologically intact after apoptosis; this observation suggests a basis for the targeting of pathological and autoimmunechanges to biliary epithelial cells.