Causes and risk profiles of mortality among individuals with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States and worldwide. Though nonalcoholic fatty liver per se may not be independently associated with an increased risk for all-cause mortality, it is associated with a number of harmful metabolic risk factors, such as type 2 diabetes mellitus, hyperlipidemia, obesity, a sedentary lifestyle, and an unhealthy diet. The fibrosis stage is a predictor of all-cause mortality in NAFLD. Mortality in individuals with NAFLD has been steadily increasing, and the most common cause-specific mortality for NAFLD is cardiovascular disease, followed by extra-hepatic cancer, liver-related mortality, and diabetes. High-risk profiles for mortality in NAFLD include PNPLA3 I148M polymorphism, low thyroid function and hypothyroidism, and sarcopenia. Achieving weight loss through adherence to a high-quality diet and sufficient physical activity is the most important predictor of improvement in NAFLD severity and the benefit of survival. Given the increasing health burden of NAFLD, future studies with more long-term mortality data may demonstrate an independent association between NAFLD and mortality.

Evaluation and management of extrahepatic manifestations of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a multisystemic disease and a rapidly growing cause of chronic liver disease in children and adults worldwide. Diagnosis and management of extrahepatic manifestations of NAFLD, including cardiovascular disease (CVD), type 2 diabetes mellitus, metabolic syndrome, chronic kidney disease, obstructive sleep apnea, polycystic ovarian syndrome, hypothyroidism, psoriasis, and extrahepatic malignancy are crucial for the treatment of patients with NAFLD. The leading cause of death in NAFLD is primarily from CVD, followed by liver-related mortality, extrahepatic cancer, liver cancer, and diabetes-related mortality. Therefore, clinicians need to identify high-risk patients earlier in the disease course and be aware of the extrahepatic manifestations of NAFLD to improve liver disease outcomes. In this review, we focus on the monitoring and management of the extrahepatic manifestations of NAFLD.

Evaluation and management of extrahepatic manifestations of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a multisystemic disease and a rapidly growing cause of chronic liver disease in children and adults worldwide. Diagnosis and management of extrahepatic manifestations of NAFLD, including cardiovascular disease (CVD), type 2 diabetes mellitus, metabolic syndrome, chronic kidney disease, obstructive sleep apnea, polycystic ovarian syndrome, hypothyroidism, psoriasis, and extrahepatic malignancy are crucial for the treatment of patients with NAFLD. The leading cause of death in NAFLD is primarily from CVD, followed by liver-related mortality, extrahepatic cancer, liver cancer, and diabetes-related mortality. Therefore, clinicians need to identify high-risk patients earlier in the disease course and be aware of the extrahepatic manifestations of NAFLD to improve liver disease outcomes. In this review, we focus on the monitoring and management of the extrahepatic manifestations of NAFLD.

Recent Epidemiology of Nonalcoholic Fatty Liver Disease

The ongoing obesity epidemic and the increasing recognition of metabolic syndrome have contributed to the growing prevalence of nonalcoholic fatty liver disease (NAFLD), the most common form of liver disease worldwide. It is imperative to understand the incidence and prevalence of NAFLD as it is associated with a profound economic burden of hospitalizations, including the shifting trends in liver transplantation. The long-term cumulative healthcare cost of NAFLD patients has been shown to be 80% higher than that of non-NAFLD patients. We explore diagnostic challenges in identifying those with NAFLD who have a higher predilection to progress to end-stage liver disease. We aim to assess all-cause and cause-specific mortality as it relates to NAFLD.

Extrahepatic Manifestations of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and encompasses a spectrum of pathology from simple steatosis to inflammation and significant fibrosis that leads to cirrhosis. NAFLD and its comorbid conditions extend well beyond the liver. It is a multisystemic clinical disease entity with extrahepatic manifestations such as cardiovascular disease, type 2 diabetes, chronic kidney disease, hypothyroidism, polycystic ovarian syndrome, and psoriasis. Indeed, the most common causes of mortality in subjects with NAFLD are cardiovascular disease, followed by malignancies and then liver-related complications as a distant third. This review focuses on several of the key extrahepatic manifestations of NAFLD and areas for future investigation. Clinicians should learn to screen and initiate treatment for these extrahepatic manifestations in a prompt and timely fashion before they progress to end-organ damage.

Deep venous thrombosis; mean platelet volume, D-Dimer and doppler sonography. patients of surgical wards of liaquat university hospital

Objectives: To study mean platelet volume [MPV] in deep venous thrombosis [DVT] as evaluated by D-Dimmer and Doppler sonography. Study Design: Case control study. Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from May 2013 to April 2014

Subjects and Methods: A sample of 106 subjects; 50 controls and 53 diagnosed patients of DVT were studied. DVT patients were included according to inclusion and exclusion criteria and after results of Sonography and D-Dimer were available. The Blood samples were collected in bottles containing sodium citrate as anticoagulant. MPV was generated by Sysmex KX 21 hematology analyzer. Informed consent was sought from the volunteer subjects. The Data was analyzed using SPSS version 21.0. Statistically significance was defined at p-value of

Results: Mean platelet volume was elevated in deep venous thrombosis patients which were confirmed by clinical examination, sonography and D-Dimer. MPV was elevated in cases; 10.0 +/- 0.7fl compared to controls; 9.55 +/- 0.63fl [p=0.001]. D-Dimmer was elevated in deep venous thrombosis patients [p=0.0001]. Age, gender and platelet counts did not revealed any significant differences between cases and controls [p>0.0.05]

Conclusion: The present study reports elevated MPV in patients suffering from deep venous thrombosis and it is concluded that MPV may be considered as a risk factor for DVT

Combination of Hot-Hypertonic Saline and pressure dressing in the management of Parotid Fistula

Parotid fistula is a rare complication of surgical or non-surgical trauma on or in the vicinity of parotid gland. Many pharmacological agents and surgical methods are used to treat it with their own merits, demerits and patient preferences. Injection of hypertonic hot saline along with compression dressing is an economical, patient-preferred and almost complication-free method to deal parotid fistula with promising results

Venous thromboembolism [VTE]: risk assessment in hospitalized patients

To determine the number of hospitalized patients at risk for developing venous thromboembolism [VTE] / deep vein thrombosis [DVT], identifying the most common risk factor and to document the use of thromboprophylaxis. Observational and cross-sectional study. Chandka Medical College Hospital, Larkana, from October to December 2011. A total of 170 patients underwent this study and these included 51 [30%] from general medical, and 119 [70%] from surgical units. Inclusion and exclusion criteria were defined and data was collected on printed format. VTE risk assessment was done according to Caprini Model and criteria defined by the American College of Chest Physicians- ACCP. Out of 170 patients, 91 were male and 79 female with mean age of 39 +/- 16 years. According to ACCP criteria for VTE risk assessment, 20% [n=34] patients were identified to be at low risk, 20% [n=34] at moderate risk, 47.65% [n=81] at high risk and 12.35% [n=21] at very high risk of developing VTE. The commonest risk factor significantly identified was immobility [54.7%, p < 0.005], followed by advancing age [41.17%, p < 0.005] and obesity [18.23%]. The most common risk factor in all types of surgical patients was anaesthesia for more than 45 minutes 82.35% [n=98/119] and in medical patients advancing age 45% [n=23/51]. Only 6 [3.5%] patients received thromboprophylaxis, all were surgical patients of very high-risk category. Majority of studied hospitalized patients were at high risk of developing VTE. Immobility was the commonest risk factor for developing VTE, followed by advancing age and obesity. Very few hospitalized patients actually received thromboprophylaxis

Role of laparoscopy in blunt abdominal trauma

To evaluate the role of laparoscopy in the diagnosis and management of blunt abdominal trauma. This descriptive, prospective study was conducted in the departments of surgery, Ghulam Mohammad Mahar Medical College, Sukkur and Chandka Medical College, Larkana, Pakistan from June 2010 to May 2012. It included 32 patients with blunt abdominal trauma admitted in emergency at GMMMC, Sukkur and at CMC Larkana. Initially, all were resuscitated with iv fluids, analgesics, iv antibiotics and blood transfusion, if required and then investigated by ultrasound abdomen, plain x-ray abdomen and chest and other routine investigations. Laparoscopy was performed in hemodynamically stable patients not showing free gas under the diaphragm in plain x-ray abdomen and ultrasound showing hemoperitoneum. The patients with penetrating abdominal wounds, non-traumatic abdominal emergencies and iatrogenic injuries were excluded. Out of 32 parents, 29 were male and only 3 were female. The age ranged from 12 to 60 years. The organs injured were spleen in 5 [15.6%] patients, liver in 17 [53.12%], omental bleeding in 2 [6.25%], small bowel mesenteric bleeding in 6 [18.75%] and associated Jejunal [injuries in 2 [6.25%] patients. Only 3 [9.37%] patients with Grade-iii liver injury developed post- operative collection, 1 [3.12%] patient developed biliary fistula and 1 [3.12%] developed right sided pleural effusion. No post-operative bleeding or mortality was recorded. Laparoscopy could be useful in selected patients with blunt abdominal trauma as a diagnostic and therapeutic tool, thus avoiding unnecessary laparotomies

Comparison of efficacy of thioridazine with clonidine acting through different mechanisms in acute opioid abstinence syndrome

To compare the efficacy, safety and tolerability of thioridazine with clonidine in patients with Acute opioid Abstinence Syndrome. This single blind comparative clinical trial was carried out at Department of Pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Center [JPMC], Karachi. Fifty two addicts were selected randomly and were grouped into, group-A to received thioridazine 100 mg/day and group -B to received clonidine 150mcg/day. All participants completed the treatment program and stayed in hospital for ten days. The efficacy safety and tolerability of thioridazine was scant, while clonidine showed statistically significant turn down in the objective signs of acute opioid abstinence syndrome. Clonidine had more powerful effects than thioridazine. While treating the withdrawal signs of opioid abstinence syndrome may possibly pointed out that over activation of norepinephrine is a major factor contributes to the commencement of opioid abstinence syndrome

Frequency of dominant blood groups in medical students of Karachi

1. To assess the different blood groups, in students of DUHS. 2. To determine the dominant blood group in the students of DUHS. 3. To compare the results of present study with other cities of Pakistan and countries of the world. Cross-sectional study. This study was carried out on medical students of Sindh and Dow medical Colleges, [DUHS] Karachi from September 2000-2004. Sample size of 2300 was drawn by using convenient sampling method. Blood samples were collected by finger prick method. Data was collected and analyzed on SPSS version 16. Out of 2300 students group B was found to be the commonest [40%], group O [32%], group A [20%], group AB [08%].Rh positive [85%].The dominant being B+ in karachi as well in Pakistan, compared to O blood group in different countries of world. The study showed very little%[08] of blood [AB] groups among the medical students of Karachi; it generated an authentic data, which may serve a useful purpose for high transfusion demand to very emergent situations

outcome of well's operation in the surgical management of rectal prolapse

To see the outcome of Well's operation in the surgical management of rectal prolapse. Quasi Experimental study. This study was carried out in Department of surgery, Liaquat University of Medical and Health Sciences, Jamshoro from 11-5-2006 to 10-05-2009. This study consisted of 30 cases of rectal prolapse admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro. Detailed History was taken from all the patients with special regard to the rectal prolapse. Inclusion criteria were that all the adults patients [Male and female] of rectal prolapse on the basis of history and fit for anesthesia and surgery were included in the study. Exclusion criteria included unfit patients for general anesthesia, another local pathology like haemorrhoids or rectal tumor. Data was analyzed through SPSS software. Out of 30 cases, 14[46.7%] were males and 16[53.3%] were females. There was wide variation of age with mean age + SD was 40.67 + 12.4 years. Most of the patients had constipation 23[76.7%] cases, 20[66.6%] cases were presented with Mucus discharge, 11[36.6%] cases had urinary incontinence, 09[30.0%] cases had Diarrhoea and 07[23.3%] cases had bleeding. Co-morbidity factors were diabetes mellitus in 07[23.3%] cases, hypertension was present in 09[30.0%] and IHD was found only in 02[6.7%]. Ten [33.3%] cases were anemic, 05[16.66%] cases with HBsAg, 07[23.3%] had Hepatitis C and only 1[3.3%] case had duel viral infection. Complications were seen in all the cases, 28[93.3%] cases were found in majority who had pain after the procedure, 08[26.7%] cases developed the wound infection associated with retention of urine, 05[16.7%] had urinary incontinence associated with reactionary haemorrhage, 07[13.3%] had anal stenosis associated with incisional hernia, 01[3.3%] were found with ureteric damage, 03[10.0%] cases had sexual dysfunction and only 1[3.3%] case had Rectal stricture. Recurrence of rectal prolapse occurred in only 1[3.3%] patient. In conclusion, this study suggests that Wells operation may be a good choice for treatment of complete rectal prolapse, in view of its low complication and recurrence rates

comparative study on factors causing job dissatisfaction among serving doctors at teaching hospitals of Hyderabad, Pakistan

To determine the main factors of job dissatisfaction among doctors serving in teaching hospitals of Hyderabad, Pakistan. One public sector teaching hospital, i.e., Liaquat University of Medical and Health Sciences Jamshoro and one private teaching hospital, i.e., ISRA University Hospital Hyderabad was selected as study places. Doctors working on contract, part time or having service less than one year were excluded. A pre- tested mailing questionnaire was sent to each one and their response was analyzed on SPSS version 15. Out of 300 questionnaires, 248 were received correctly. Among the respondents, 76.2% doctors were found to be completely dissatisfied with their jobs. Whereas, the mean score for satisfaction characteristics were lowest for working environment [2.12 +/- 0.07], Pay and Perks [2.13+0.08] and work load [2.14 +/- 0.08]. Only the category of Professor showed total satisfaction being 67%, while qualification wise analysis showed none of the degree holders was totally satisfied. On the basis of this study, showing dissatisfaction of hospital doctors towards job conditions, it is suggested to improve job conditions/characteristics with emphasis on the improvements in working environment, pay scale and work load

comparative study of trans urethral resection versus trans urethral incision for small size obstructing prostate

To compare the results of transurethral resection of prostate [TURP] with transurethral incision of prostate [TUIP] for small size obstructing prostate. Comparative study. Department of Urology, Peoples University of Medical and Health Sciences for women Hospital Nawabshah, from 2008 to 2010. Patients were divided in TURP and TUIP groups with fifty patients in each. Patients of any age with small size [thirty grams or less] prostate needing surgical intervention were included. TURP was done with conventional technique. In TUIP two deep incisions were made at 5 and 7'O clock positions of the bladder neck using Collings knife. Pre-per and postoperative variables were observed and recorded. All patients were followed up to six months post operatively. A total of 100 patients were included in the study. Mean operative time was 12.4 minutes in TUIP and 22.6 minutes in TURP. Retrograde ejaculation and blood transfusions were less in TUIP than TURP. The improvement in maximum flow rate improved in both the groups. TUIP is as effective as TURP in achieving maximum flow rate but TUIP was superior in terms of shorter operative time, less retrograde ejaculation and less need of blood transfusion

Vesico-vaginal fistula abdominal repair versus repair via vaginal route

To evaluate the outcome of Vesico-vaginal Fistulae [VVF] repair by abdominal and vaginal route. Interventional / clinical trial. Department of Urology, Chandka Medical College Teaching Hospital and Almas Medical Centre Larkana. Feb; 2005 to Nov; 2010. After routine clinical examination and investigation, patients having Vesico-vaginal Fistulae [VVF] were selected for repair. All patients had under gone examination those anesthesia [EUA] and cystoscopy. The patients having complex fistulae or associated with urethral, ureteric and colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Patients were divided in to 02 groups on the basis of the site of the fistula and the method of repair. Group-I comprised of those patients who had low type or uncomplicated fistulae and were operated by vaginal approach. Group-II consisted of those patients who had high type or large fistulae and were operated by abdominal approach. Postoperative follow up was carried out on weekly basis for 03 to 06 months. Our study included 32 cases. Group-I and II comprised of 18 and 14 patients respectively. The mean age was 34 years [ranged from 22 to 45 years]. The main cause of vesico-vaginal fistulae was obstetrical in 28[87.5%] and iatrogenic gynecological [hysterectomy] in 04 [12.5%] patients. No major difficulty was experienced except in 01[0.83%] case in group-1 who had a previous failure history of repair. The mean operative time was 95 minutes [range 80 to 125 minutes] and 145 minutes [range 110 to 175 minutes] in group-1 and group-2 respectively. Peroperative blood transfusion was required in 06 [33.33%] and 13 [93%] patients of group-1 and group-II respectively. Statistically significant difference was found between these two groups [P< 0.05]. Postoperative complications like wound infection occurred in 01[7.15%] of group- 1 and haematuria was present for few days in o4 [22.22%] and 05[35.5%] in group-1 and group-2 respectively. The mean hospital stay was 07 [range 5-10] days. Foleys catheter was removed at 02 week time in all cases. The success rate was achieved 15[83.33%] and in all 14 [100%] cases for group-1 and group-2 respectively and statistically no significant difference was found between two groups [P=NS]. All the patients were followed up regularly except 03 [16.5%] and 05 [35.5%] patients of group-1 and group-II respectively. Long term complications like urinary stress incontinence was observed in 2 [11.1%] patients of group-I, where as small capacity bladder and stone formation was observed in 02[14.3%] of group-11 cases. Birth trauma is still a major cause of vesico vaginal fistula in our region. Although, there is no significant difference in outcome of different technique but interposition of tissue between suture lines have a vital role to achieve a high success rate. Further more, best chance of success achieved with first attempt of repair. Strategic approach and proper training of medical and paramedical staff is recommended

Tumor markers: chemistry, diagnostic utility and prognostic significance: a review

According to National Cancer Institute [NCI-NIH-USA], tumor markers are substances that are produced by cancer or by other cells of the body in response to cancer or certain benign [noncancerous] conditions. Most tumor markers are made by normal cells as well as by cancer cells; however, they are produced at much higher levels in cancerous conditions. These substances can be found in the blood, urine, stool, tumor tissue, or other tissues or bodily fluids of some patients with cancer1. Most tumor markers are proteins. However, more recently, patterns of and changes to DNA have also begun to be used as tumor markers. Markers of the latter type are assessed in tumor tissue specifically

A detailed information available on the website of NCI-NIH that so far more than 20 different tumor markers have been characterized and are in clinical use. Some are associated with only one type of cancer, whereas others are associated with two or more cancer types. There is no "universal" tumor marker that can detect any type of cancer [NCI-NIH-USA, accessed 3/13/2013]

There are some limitations to the use of tumor markers. Sometimes, noncancerous conditions can cause the levels of certain tumor markers to increase. In addition, not everyone with a particular type of cancer will have a higher level of a tumor marker associated with that cancer. Moreover, tumor markers have not been identified for every type of cancer [1, NCI-NIH-USA, accessed 3/13/2013]. The present review details the chemistry, structure, diagnostic and prognostic utilities of 7 tumor makers including CA 27.29, CEA, CA 19.9, AFP, CA 125, PSA and CA 15-3 for current information and upgrading regarding its usefulness and significance in disease evaluation, progression and treatments. The information provided below gathered mainly through PubMed search engine of nearly 300 articles from year 2000 to 2013, Wikipedia, cancer related sites and American Family Physician journal [2003/vol 68,, Perkins et al. , 2003]

Are students of Isra university sleep deprived; a prospective study

To assess the sleep pattern of students of Isra University using Pittsburgh sleep quality index and Epworth sleepiness scale. Descriptive study. This study was conducted at Isra University medical college Hyderabad Sind from Jan 2010 to June 2010. One hundred medical students of various batches of Isra University were randomly selected for this study. There were 57 females and 43 males. All were given instructions to fill the questionnaires of Pittsburgh sleep quality index and Epworth sleepiness scale. These were then collected and analyzed. Among the students mean Epworth score was 8.37 +/- .342 and the mean Pittsburgh score was 5.99 +/- 0.322. Pittsburgh score was above the reference value. There was no difference in these scores between male and female students. In 34% students, Epworth score was above 9 and in 55% students Pittsburgh score was above 5. Both scores were higher in more female students than males. 26% students had less duration of sleep and 13% had difficulty in daily routine due to insufficient sleep. It is concluded that Sleep as assessed by using Epworth sleepiness scale was within normal range. Mean Pittsburgh sleep quality index was above normal range indicating poor sleep quality. Duration of sleep was mainly affected

Diagnostic utility and Assessment of C - reactive protein [CRP] in patients with community acquired pneumonia

It has been researched and agreed upon that pneumonia elicits a powerful inflammatory response with the release of inflammatory mediators or biomarkers, such as acute-phase proteins, inteleukin-6 and C-reactive protein [CRP] from activated mononuclear phagocyte cells. It is also known and recommended that the early analysis of serum concentrations of CRP is a significant tool for the diagnosis and monitoring of different acute inflammatory processes. Community-acquired pneumonia [CAP] is documented to be the major cause of death in the western world and effects increasing number of population annually. In present study we have investigated the suggested usefulness of serum CRP levels in patients with CAP at the time of diagnosis and compared it with CRP of healthy controls. One hundred and seventy one [n = 171] patients were included in the study and classified according to presence of pathogens/ etiology in individual capacity as well as in combination with other organisms. All microbiological assays were performed according to standardized procedures, whereas CRP was measured in serum samples by an automated turbid metric method with normal reference of

Diagnostic importance of C-reactive protein [CRP] analysis in tuberculosis pleural effusions

One of the acute-phase biomarkers that have recently been investigated for its clinical utility in tuberculosis pleural effusion is C-reactive protein [CRP] which has already been commonly used as a marker of inflammation and tissue injury. Therefore, the present study was undertaken to analyze the viability of CRP as a diagnostic aid for tuberculosis in lymphocytic pleural effusions. Fifty two [n = 52] patients with lymphocytic pleural effusion with definite diagnosis of a disease condition, were taken into the test group and classified into no tuberculosis [n = 28] group and tuberculosis pleurisy group where sputum culture was positive for Mycobacterium tuberculosis in pleural effusion [n = 24]. CRP in pleural fluid was analyzed by automated turbid metric immunoassay method as per description of the manufacturer and normal reference value in serum is

Diffuse fibrous pseudotumor of paratesticular tissue

Paratesticular tumors are uncommon and comprise less than 5% of all intra-scrotal tumors. Fbrous pseudotumours are reactive fibrous proliferations of inflammatory and fibrous tissue, usually in response to surgery, trauma, infection, or inflammation. We present a case of a 25 years old male patient who presented with an asymptomatic firm non-tender right testicular swelling. Plasma HCG and alpha fetoprotein [AFP] levels were within normal limits. A total right orchidectomy and epididymectomy revealed normal testis completely encased by a thick firm fibrotic band of tissue. A diagnosis of diffuse fibrous pseudo tumor of para testicular tissue was made on histology. The possibility of fibrous pseudotumor of paratesticular tissue should be considered in young patients presenting with testicular swellings and normal tumor markers