Non-alcoholic fatty liver diseases: update on the challenge of diagnosis and treatment

The prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated to be 25-30% of the population, and is the most common cause of elevated liver enzymes in Korea. NAFLD is a "hot potato" for pharmaceutical companies. Many clinical trials are underway to develop a first-in-class drug to treat NAFLD. However, there are several challenging issues regarding the diagnosis of NAFLD. Currently, liver biopsy is the gold standard method for the diagnosis of NAFLD and steatohepatitis. Ideally, globally recognized standards for histological diagnosis and methods to optimize observer agreement on biopsy interpretation should be developed. Liver biopsy is the best method rather than a perfect one. Recently, multi-parametric magnetic resonance imagery can estimate the amount of intrahepatic fat successfully and is widely used in clinical trials. But no diagnostic method can discriminate between steatohepatitis and simple steatosis. The other unresolved issue in regard to NAFLD is the absence of satisfactory treatment options. Vitamin E and obeticholic acid have shown protective effects in randomized controlled trials, but this drug has not been approved for use in Korea. This study will provide a description of diagnostic methods and treatments that are currently recommended for NAFLD.

Situational analysis: preliminary regional review of the Mental Health Atlas 2014

The WHO comprehensive Mental Health Action Plan 2013-2020 established goals and objectives that Member States have agreed to meet by 2020. To update the Atlas of Mental Health 2011, specific indicators from the Mental Health Action Plan and additional indicators on service coverage were incorporated into the questionnaire for the Atlas 2014. The data will help facilitate improvement in information gathering and focus efforts towards implementation of the Mental Health Action Plan. The questionnaire was completed by the national mental health focal point of each country. This preliminary review seeks to consolidate data from the initial response to the Atlas 2014 questionnaire by Member States in the Eastern Mediterranean Region. Data for this review were analysed for the whole Region, by health systems groupings and by individual countries. Where possible, data are compared with the Mental Health Atlas 2011 to give a longitudinal perspective

Reorganization of mental health services: from institutional to community-based models of care

Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: [1] integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; [2] systematically strengthen the capacity of non-specialized health personnel for providing mental health care; [3] scale up community-based services [community outreach teams for defined catchment, supported residential facilities, supported employment and family support]; [4] establish mental health services in general hospitals for outpatient and acute inpatient care; [5] progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and [6] provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel

Combination therapy versus monotherapy for gastroesophageal reflux in children with difficult-to-treat bronchial asthma

Gastroesophageal reflux [GER] is a common disorder in children with bronchial asthma. Difficult-to-treat asthma; It has been identified as a potential trigger, complication and even differential diagnosis for asthma. GERD; Our aim was to find out the efficacy of the combined use of both the proton pump inhibitor esomep-Proton pump inhibitors; razole and the antidopaminergic prokinetic domperidone versus the sole use of esomeprazole in Prokinetics improving asthma severity in children with difficult to treat asthma. Among 178 children with difficult-to-treat asthma, GER was assessed using upper GIT endoscopy. Those who had GER were randomly divided into 2 equal subgroups the first was treated with esomeprazole for 12 weeks while the other was treated with esomeprazole and domperidone for the same period [beside the usual treatment for asthma in both groups]. Childhood-asthma control test [C-ACT], forced expiratory volume in 1st second [FEVj] [% of predicted], peak expiratory flow [PEE] variability, induced sputum substance P [SP] and endoscopic reflux score [ERS] were recorded before and after the treatment. Gastro-esophageal reflux [GER] was observed in about 45% of children with difficult-to-treat asthma. The C-ACT, induced sputum SP, ERS and FEVj showed significant improvement while PEE variability showed no significant changes when comparing combination therapy subgroup [esomeprazole and domperidone] with esomeprazole only subgroup combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test [C-ACT] and FEVj [% of predicted] and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma

effect of duration of finishing and polishing on the surface roughness of two composite resins

The purpose of this study was to evaluate the effect of duration of finishing and polishing procedures on the surface roughness of two different types of composite resins. Forty samples of 6 mm in diameter and 2 mm in depth were prepared, 2 types of composite resins were used [nanocomposite and hybrid composite resin]. Twenty samples of each type of material were prepared and divided into two main groups and then each main group subdivided randomly into two subgroups of 10 samples for each subgroup [one]. Ten samples of each material were submitted to finishing by using a finishing kit. The available finishing kits used in this study containing discs, cups and points that were used with a slow-speed hand piece in a dry field and with a light intermittent pressure for about 15 seconds. While the other 10 samples of each material were finished for about 30 second; then the analysis of the surface roughness was carried out, three readings were made on each surface using a stylus tip and the extension of each reading was 2 mm stroke. There was non significant difference between the groups that were finished and polished for 15 second and the other groups that were finished and polished for 30 second for the two different types of composite resin. Increasing duration of finishing and polishing has no effect on the surface roughness of the two different types of composite resin

psychosocial environment at work: an assessment of the World Health Organization Regional Office for the Eastern Mediterranean

Psychosocial risks are widely recognised as major challenges to occupational health and safety. The risk management approach, which starts with an assessment of the risk that they pose, is acknowledged as the most effective way of preventing and managing psychosocial risks at the workplace. This paper presents the findings and action taken following a risk assessment of psychosocial risks, at the World health Organization Regional Office for the Eastern Mediterranean [EMRO] and country offices, carried out on behalf of the Committee on Health and Safety in the Workplace in EMRO. The findings show that psychosocial risks pose a threat to the mental well-being of staff. Management and co-worker support, rewards, possibilities for development, and trust mitigate the negative impact of psychosocial risks. The results of this risk assessment are being used to develop interventions aimed at enhancing the sense of we 11-being of staff, initially through actions at the employee level

Antimicrobial-resistant bacteria in a general intensive care unit in Saudi Arabia

To assess the prevalence of multi-drug resistant [MDR] bacteria causing infections in patients at the intensive care units [ICUs] of Riyadh Military Hospital [RMH], as well as their antimicrobial resistance patterns for one year. A retrospective, cohort investigation was performed. Laboratory records from January to December 2009 were studied for the prevalence of MDR Gram-negative and Gram-positive bacteria and their antimicrobial resistance in ICU patients from RMH, Riyadh, Kingdom of Saudi Arabia. A total of 1210 isolates were collected from various specimens such as: respiratory [469], blood [400], wound/tissue [235], urinary [56], nasal swabs [35], and cerebro-spinal fluid [15]. Regardless of the specimen, there was a high rate of nosocomial MDR organisms isolated from patients enrolled in the General ICU [GICU] in Riyadh. Acinetobacter baumannii [A. baumannii] comprised 40.9%, Klebsiella pneumonia [K.pneumonia] - 19.4%, while Pseudomonas aeruginosa [P. aeruginosa] formed 16.3% of these isolates. The P. aeruginosa, A. baumannii, K. pneumoniae, Escherichia coli, Staphylococcus aureus [methycillin sensitive and methycillin resistant], and Staphylococcus coagulase negative are the most common isolates recovered from clinical specimens in the GICU of RMH. Respiratory tract specimens represented nearly 39% of all the specimens collected in the ICU. The most common MDR organisms isolated in this unit were A. baumannii, and K. pneumoniae

anti-inflammatory properties of interleukin 18 binding protein in rheumatoid arthritis

Interleukin-18 binding protein [IL-18BP] is functioning as a natural anti-inflammatory and immunosuppressive molecule by neutralizing the effects of IL-18 during inflammation. This study aimed to identify the role of IL-18BPa in the regulation of immune responses associated with the pathogenesis of RA. 65 RA patients, 22 OA patients, and 40 sex and age matched healthy donors were enrolled in this study. Synovial specimens were obtained through synovectomy or arthroscopic procedures. SFMC and PBMC were prepared by using Ficoll-Hypaque separation procedure. Superarray analysis was used to measure the expression profile of immune-related genes in normal PBMC treated with recombinant human IL-18BPa. The mRNA levels of Th1 and Th2 cytokines were measured by Real-time PCR, and the protein levels of IFN-gamma, IL-4 were detected by ELISA. SuperArray analysis of immune related gene expression profile in normal PBMC treated with IL-18BPa indicated decreases in the gene expression of IFN- gamma and its regulatory molecules STAT-1 and STAT-2. This study pointed out that IL-18BPa has additional anti-inflammatory property through downregulating the expression of IFN- gamma and IL-12, at the same time, upregulating the expression of IL-4 and IL-10. Both IFN- gamma and IL-12 could upregulate the mRNA and protein levels of IL-18BPa in both the normal and RA subjects. Our results demonstrated the importance of IL-18BPa as an immune regulatory molecule and as a promising therapy for treating RA

Hydrogen peroxide 3%: Is it beneficial in tonsillectomy?

The world over, tonsillectomy is one of the operations most frequently performed by otolaryngologists, who are in search of a technique of tonsillectomy where the operation time and operative blood loss is reduced. This study was carried out to evaluate the effect of hydrogen peroxide 3% on tonsillectomy times, blood loss during the surgery and on the number of ties used. A pilot study of 30 patients was carried out in the Department of Otolaryngology of Basrah General Hospital, Iraq, in the period from February to July 2006. Tonsillectomy was performed using hydrogen peroxide 3% as a haemostatic agent in Group A [n = 15], while in Group B [n = 15] no agent was used with the gauze pack. The application of hydrogen peroxide 3% in the tonsillar fossae reduced the operation time by 31%, the operative blood loss by 32.9% and also reduced the number of ties used by 50% in Group A. All these results are statistically significant. The local application of 3% hydrogen peroxide on the tonsillar bed after tonsillectomy is beneficial in regard to decreasing the procedure time, the volume of blood loss, and the number of ties used

Hydrogen peroxide 3%: Isit beneficial in tonsillectomy?

Tonsillectomy is one of the most frequent operations performed by otolaryngologists world over. Otolaryngologists are in search of a technique of tonsillectomy where the operation time and operative blood loss is less. This study was carries out to evaluate the effects of hydrogen peroxide 3% on tonsillectomy time, blood loss during the surgery as well as on the number of ties used. A prospective randomized trial of 30 patients was carried out, in which tonsillectomy peiformed in the department of otolaryngology, Basrah General Hospital in Iraq, using hydrogen peroxide 3% as haemostatic agent on one side and on the other side no agent was used with gauze pack. Application of hydrogen peroxide 3% in the tonsillar fossae reduces the operation time by 31% the operative blood loss by 32.9% and also reduces the number of ties used by 50% in regard to control side. All these results are statistically significant. Local application of 3% hydrogen peroxide on tonsillar bed after tonsillectomy is beneficial in regard to decrease the procedure time, the volume of blood loss, as well as number of ties used

In vitro study assessing the response of plasmodium falciparum malaria to chloroquine, sulfadoxine/pyrimethamine, quinine and mefloquine in Wad Medani district, Sudan

To assess the in vitro response of Plasmodium falciparum malaria to chloroquine [CQ], sulfadoxine/pyrimethamine [SDX/PYR], Quinine [QU] and Mefloquine [MQ] and monitoring their resistance. In 1999 to 2000, an in vitro study was carried out in Wad Medani district in Sudan. The standard protocol of the WHO in vitro micro-test Mark II was used for the selection of the subjects, the collection of blood samples, the culture techniques, the examination of the post-culture blood slides and the interpretation of the results. In vitro micro-test Mark II were performed on 62 Plasmodium falciparum isolates. Of these isolates, 42 produced successful schizonts growth. The data obtained showed that 29 of 42 isolates [69%] were CQ resistant with an effective concentrations [EC]; EC50 = 399.621 nM, EC90 = 2754.145 nM and EC99 = 13284.967 nM to inhibit the schizont maturation, the values of SDX/PYR showed a flat regression line as an indication of in vitro reduced response with an EC50 = 0.262 nM, EC90 = 147.390 nM and EC99 = 25722.296 nM, and the response to the QU indicated only one of the 42 isolates [2.4%] was resistant with an EC50 = 150.085 nM, EC90 = 822.825 nM and EC99 = 3293.667 nM, while all the 42 isolates were sensitive to MQ with an EC50 = 190.763 nM, EC90 = 615.125 nM and EC99 = 1597.504 nM. The results of this study revealed a high degree of in vitro resistance to CQ and reduced in vitro response to SDX/PYR and QU, while MQ was fully sensitive. The effective concentrations to inhibit 50, 90 and 99% of the parasite maturation were determined for antimalarial drugs efficacy monitoring surveillance in Sudan

Schistosoma mansoni associated mortaiity in Gezira: Determined by clinical and ultrasound examination

Schistosomiasis is the most common problem in Gezira area. The prevalence among school children could reach up to 90% in some villages. This study was conducted in a small village in the Gezira area in central Sudan. This part of the Gezira is well known for its high endemicity of Bilharzia. A total of 428 individuals were included in the study. All were examined clinically and by Ultrasoungraphy for spleen and liver. Stoll specimens were also taken from all the subjects and were examined for Schistosoma mansoni ova. The prevalence of schistosomasis was found to be 72% in males and 68 3% in females. It was also observed that the overall prevalence of splenomegaly on the examined subjects was 35.8%. Males recorded higher prevalence of splenomegaly [38.8%] compared to females [32.7%] [p =/< 0.05]. The observed prevalence of hepatomegaly was 12.6%., with high prevalence among males [13.1%] compared to females [11.2%]. Out of the 406 subjects examined by ultrasound, 266 [63.1%] were found to have evidence of periportal fibrosis. The hepatomegaly in the different grades1.2 and 3 are 12.6%, 3.8% and 0% respectively. It is clear from the above data that the size of the spleen increases while the size of the liver decreases with the severity of periportal fibrosis

Nephrotic syndrome following Schistosoma mansoni

A young Sudanese female presented with features of generalized edema for the last three years. Examination showed anasarca, hepatomegaly and anemia. Investigations confirmed the presence of Nephrotic syndrome with normal renal function. It also showed iron deficiency anemia and leukamoid reaction, hypereosinophilia. Causes for hypereosinophilia were excluded. Renal biopsy showed the diagnosis of amyloidosis. Stool by concentration method diagnosed. Schistosoma mansoni as possible explanation for all the, manifestations. Leucocytosis, hypereosinophilia responded to steroids and antihelminthic therapy however the patient glomerulopathy progressed to end stage and the patient was put on regular renal replacement therapy

Early vs interval laparoscopic cholecystectomy in the management of symptomatic gallstones

One hundred and fifty one patients that underwent laparoscopic cholecystectomy at Princess Alexandra Hospital Harlow were identified between January 2005 and October 2005. They were grouped according to their diagnosis [biliary colic, acute cholecystitis, CBD stones, gallstone pancreatitis] and the delay until their operation [early, interval]. The delay for an interval operation was between 3 and 6 months compared with less than 2 weeks for early operations. No disadvantage was found for early LC for biliary colic. Interval cholecystectomy for all symptomatic gallstones was associated with multiple pre-operative presentations particularly if the initial presentation was to A and E [p=0.003]. Complication rates were also higher. Early cholecystectomy on the nest available list should be recommended for all patients presenting to general surgical teams to lower morbidity and the long-term inpatient burden from gallstones

Regression of liver fibrosis in Schistosoma mansoni infected Sudanese subjects after praziquantel treatment

1-To evaluate the effect of Praziquantel [PZQ] therapy on the regression of liver fibrosis in an endemic population. 2-To determine the factors controlling the regression of hepatic fibrosis [e.g. gender, age and grade of fibrosis]. An association study of a cohort of one hundred seventy seven Sudanese patients infected with Schistosoma mansoni [82 males 46%, 95 females 54%] was conducted to evaluate the factors controlling the regression of liver fibrosis 39 months after treatment with PZQ using ultrasound evaluation. SPSS [Statistical Package for Social Science] software was used for statistical analysis. Chi- Square was used to compare the two phenotypes [regression and progression] in the study subjects. PPF was regressed in 63 patients [36%] from higher grades of fibrosis to lower ones. While in 24 patients [13%] the disease progressed to higher grades. In addition, the grade of PPF did not change in 90 patients [51%]. The mean values of portal vein diameter [PVD], splenic vein diameter [SVD], and index liver size [ILS] in subjects in whom PPF regressed after treatment were significantly lower than in subjects in whom the disease was progressed [P <.0001, P =.031, and P =.003 respectively].The progression of hepatic fibrosis in males [n = 15.18%] was greater than that of females [n = 9.9%]. Patients who showed regression of PPF or progression of the disease tend to cluster in certain families. Our study indicated that regression and stabilization of PPF after PZQ therapy is controlled by gender, age, grade of fibrosis, and possibly inherited factors

Oesophageal carcinoma in Sudanese patients: a retrospective study of 84 cases

A review of the clinical aspects of oesophageal carcinoma in Sudanese patients and a comparison with internationally published series. Patients and A retrospective study of 84 cases with histologically proven oesophageal carcinoma which presented to the Ear, Nose and Throat Department, Wad Medani Teaching Hospital, Wad Medani, Sudan from 1995 to 1999. All patients underwent rigid oesophagoscopy under general anaesthesia. A total number of 84 cases were reviewed. The main presenting symptom was dysphagia. Patients' ages range was 18-80 years with a mean age of 54.1 years. Thirty seven patients [44%] were 18-50 years of age and 47 patients [56%] were above 50 years. Forty eight patients [57%] were females and 36 patients [43%] were males. Female to male ratio was 1.3:1.0. Seventy five% of patients belonged to low socioeconomic groups. The most common site was the upper third of the oesophagus [71.4%] followed by the middle third [23.8%] and the lower third [4.8%]. In 95.2% the tumour was a squamous cell carcinoma and in 4.8% it was an adenocarcinoma. Oesophageal carcinoma in Sudanese patients is more common in females and occurs at a younger age group. The most affected site [71.4%] is the upper third and the most common tumour [95.2%] is the squamous cell carcinoma

Development of mental health services in Pakistan

The development of mental health services is described here. Some of the activities undertaken are outlined including intersectoral collaborations to further mental health services