Familial Clustering of Nonalcoholic Fatty Liver Disease in Family Members of Nonalcoholic Steatohepatitis Cirrhotic Patients

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is a multifactorial disorder with combination of environmental, genetic and metabolic factors that play role in the progression of disease. This study is aimed to explore the familial clustering of NAFLD among the family members of NASH cirrhotic patients and the association of insulin resistance, metabolic syndrome and genetic polymorphism with the familial clustering. Methods: This cross-sectional observational study included 50 NASH cirrhosis patient and 81 1st degree relatives. Family members were screened for fatty liver by ultrasonogram. Insulin resistance, metabolic syndrome, PNPLA3 and staging of liver stiffness by fibroscan were done. Results: Among 81 family members 47 (58.02%) were found having fatty liver. Of these 14(17.28%) had significant fibrosis. PNPLA3 polymorphism was higher (80.85%) in fatty liver group than (55.9%) without fatty liver groups. Sons (57.89%) and daughters (51.6%) were affected by fatty liver equally. Multivariate logistic regression analysis revealed that a subject with TG>150 mg/dl had 6.159 times increase in odds having NAFLD. A subject with PNPLA3 polymorphism had 3.33 times increase in odds having NAFLD. A subject with HOMA-IR >1.6 had 4.375 times increase in odds having NAFLD. Conclusion: This study indicates that there is a strong familial clustering of NAFLD along with significant fibrosis among the family members of NASH cirrhosis patients. This findings warrants screening for NAFLD among the family members of NASH cirrhosis patients especially with PNPLA3 polymorphism.

Ethical Relation between Physicians and Pharmaceutical Industries in the Perspectives of Bangladesh.

Abstract: Relation between physicians and pharmaceutical industry is required for the benefit of the patient. But it may turn into business and overthrow the patients’ benefit. The relation might be in question at present and in future. Several questions are flowing in Bangladesh. To solve these queries we have explored the situation in developed and developing countries. The physicians and associations of pharmaceutical industries developed several ethical guidelines in those countries. They have addressed the long lasting issues on gift provided to physician, cash back, sample, industry sponsored scientific meetings, research and hospitality. There are huge restrictions to ensure the right of the patient’s e.g. limitation of inexpensive gift by the pharmaceuticals, avoiding expensive medicine instead of equally effective low priced medicine. We are lacking behind to protect the patient right properly: regulation, adherence to existing guide line, lack of guidance from statutory bodies. The current scenario is far behind the right of patient. In Bangladesh it is not yet addressed either by professionals or by pharmaceutical associations. It is the immediate need to construct a guide line for physicians and pharmaceutical industry of Bangladesh.

Funds for Treatment of Hospitalized Patients: Evidence from Bangladesh.

This study was designed to explore sources of funds for health expenditure of patients if they are hospitalized. We have included 379 patients of 3 private and 7 public hospitals to estimate total expenditure. Of them, 229 (60.4%) were from public and 150 (39.6%) from private hospitals. Mean expenditure was Tk 60,613.3 and 8,262.7, and duration of hospital stay was 10.7 and 11.8 days in private and public hospitals respectively. More than half (55%) of the patients from middle class were treated in private hospitals. Of them, 278 (74.0%) were funded by themselves, 48 (12.8%) by loan with interest rate of 100% to 180%, 23 (6.1%) by loan without interest, 17 (4.5%) by losing their fixed asset, and 4 (1.1%) by begging in the street. Most of the patients did bear expenditure by themselves, followed by loan with high interest rate. ‘Distress’ selling of property was also a source. Middle-class patients could be comfortable with expenditure if they were in public hospitals.

Development and Evaluation of Sustained Release Matrix Tablets of Indapamide using Methocel K15M CR.

In the present study an attempt has been taken to develop Indapamide sustained release matrix tablet using Methocel K15M CR by direct compression method. Various amount of polymer was used in the five proposed formulations (F-1to F-5) for the study of release rate retardant effect at 26.47%, 29.41%, 32.35%, 35.29% and 38.24% of total weight of tablet matrix respectively. Then the tablets were evaluated in terms of their physical parameters (weight variation, hardness, friability and thickness), drug content and in vitro release studies. All the formulations showed compliance with pharmacopoeial standards. The in vitro dissolution study were conducted using USP 30 dissolution apparatus type I (Basket method) in 900 ml phosphate buffer (pH 6.8) at 100 rpm for a total period of 24 hours. The release mechanisms were explored and explained by Zero order, Higuchi, First order and Korsmeyer-Peppas equations. Based on the dissolution data comparison with innovator brand formulation F-3 (32.35% Methocel K15M CR w/w) was found as the best formulation. The drug release profile of this formulation was well controlled and uniform throughout the dissolution studies. The drug release of formulation F-3 followed First Order kinetic model (r2 = 0.99) and the mechanism was found to be non- Fickian/anomalous according to Korsmeyer-Peppas equation.

Ultrasonography and computer tomography evaluation of hepatocellular carcinoma with cytohistopathological correlation.

The prevalence of hepatocellular carcinoma (HCC) in Bangladesh is 35% among all liver diseases. Sonographic examinations were performed for the evaluation of 38 cases of HCC; then, CT examinations were done of these cases subsequently. Expert opinion was taken in each case for both modalities. Age, sex, clinical features, location of the hepatic lesion, multiplicity, echo-character, CT density, and, contrast enhancement were evaluated in all cases. Histocytopathology reports were collected from the patients and were correlated with the ultrasonography and CT findings. Thirty five cases were detected as HCC on ultrasonography and 36 cases in CT scan. In ultrasonography, most of the lesions (82.9%) were found in right lobe, maximum lesions (45.7%) were hypoechoic and lesion showed mosaic pattern in 68.6% cases, lateral shadowing in 34.3% and posterior acoustic enhancement in 45.7% cases. Significant difference found between mosaic pattern and lateral shadowing (p<0.05). On CT scan, majority of lesions (50%) were hypodense, 91.7% lesions were contrast enhanced. Pattern of enhancement was mostly heterogeneous. Both of the modalitics found sensitive but CT was found more sensitive, specific and accurate than ultrasonography in detecting HCC.

Presentation and endoscopic management of biliary ascariasis.

Ascaris lumbricoides is a common parasite and the most serious and dramatic presentation is hepatobiliary and pancreatic ascariasis (HPA). Therefore, this study was planned prospectively to elucidate the clinical presentation of HPA and evaluate the efficacy and safety of endoscopic intervention. In this study we documented 77 consecutive patients with HPA from January 2000 to November 2005. All the patients had endoscopically proven HPA. A total of 77 patients were included in the study. The age ranged from 6 to 80 years, with the third decade most commonly (28.6%) affected. Females were 6 times more likely to be affected than males. The commonest presentation was biliary colic (97.4%); other presentations were acute cholangitis (15.6%), obstructive jaundice (9.1%), acute pancreatitis (6.5%), choledocholithiasis (6.5%), acute cholecystitis (6.5%) and liver abscess (2.6%). In this report 51 (66.2%) had living, 10 (13%) had dead and 16 (20.8%) had both living and dead worms. Choledocholithiasis was associated only with dead worms. From one to 23 worms were found in the biliary tree. In 94.8% of cases we had to remove the worm by wide papillotomy followed by basket extraction. We did not experience any major complications during or following the procedures. Three patients had recurrent HPA during the course of follow-up (1 to 12 months). The majority of patients with HPA presented with biliary colic. This should be kept in mind in the management of an acute abdomen, especially in tropical countries. Endoscopic extraction is a safe and effective procedure for the treatment of HPA.