A Comparative Performance Assessment of Optimized Multilevel Ensemble Learning Model with Existing Classifier Models.

To predict the class level of any classification problem, predictive models are used and mostly a single predictive model is built to predict the class level of any classification problem; current research considers multiple predictive models to predict the class level. Ensemble modeling means instead of building a single predictive model, it is proposed to build a multilevel predictive model, which generalizes to predict all the class levels with an adequate percent of accuracy, that is, from 70% to 90% by applying and using a different combination of classification algorithms. In this article, a multilevel approach for selecting base classifiers for building an ensemble classification model is proposed. The rudimentary concept behind this approach is to drop lousy performing features and collinearity from the selected data set for ensemble modeling. For the evaluation of the proposed multilevel predictive model, different data sets from the University of California, Irvine, repository have been used and comparisons with the modern classifier's models have been conducted. The implementation analyses demonstrate the potency and excellence of the novel approach when compared with other modern classification models (three-layered artificial neural network, Radial Variant Function Neural Network/Fish Swarm Algorithm). The classification accuracy achieved with selected algorithms lies in the range of 70%-88.3%. Among all the selected classification algorithms, the lowest accuracy is achieved by the naive Bayes algorithm, which is close to 71.9%. However, the proposed algorithm (NB-RF-LR-SEMod), which is a combination of different classifiers, achieved a maximum accuracy of 88.3% on the Photographic and Imaging Manufacturers Association Diabetes data set, which is, by far, the best to any single classifier. Hence, this proposed work is helpful for any health care official to detect the diabetes problem at an early stage and prevent the affected person from future complications of it.

Effect of rifaximin, probiotics, and l-ornithine l-aspartate on minimal hepatic encephalopathy: a randomized controlled trial.

BACKGROUND/AIMS: Minimal hepatic encephalopathy (MHE) implies subtle impairment of cognitive functions in the absence of features of overt encephalopathy. We aimed to determine the prevalence of MHE in patients with liver cirrhosis and to find out the effect of rifaximin, probiotics, and l-ornithine l-aspartate (LOLA) individually in reversal of MHE by comparing it with placebo group. PATIENTS AND METHODS: This study was carried out in two phases. Phase I included the recruitment of 250 apparently healthy controls and extraction of normative data utilizing three neuropsychometric tests (NPTs) and critical flicker frequency (CFF) test. Phase II consisted of screening and recruitment of patients of MHE followed by drugs trial. A total of 317 cirrhotics were screened; 111 were excluded and the remaining 206 cirrhotics were screened for MHE using NPTs and/or CFF test. Of these, 124 patients with MHE were randomized to receive LOLA (n = 31), rifaximin (n = 31), probiotics (n = 32), for 2 months and were compared with patients who were given placebo (n = 30). RESULTS: Out of 206 cirrhotics, 124 (60.19%) had MHE. Among these 124 MHE patients, 87 (70.16%) patients had CFF <39Hz, 112 (90.32%) patients with MHE had two or more abnormal NPTs, and 75 (60.48%) patients had abnormality on both the CFF values and more than two abnormal NPTs. Intention-to-treat analysis showed the number of patients who improved after giving treatment were 67.7% (21/31), 70.9% (22/31), 50% (16/32), and 30% (9/30) for LOLA, rifaximin, probiotics, and placebo, respectively. CFF scores and improvement in psychometric tests after treatment were significantly higher (P < 0.05) for LOLA, rifaximin, and probiotics as compared with placebo group. CONCLUSIONS: Prevalence of MHE is high in patients with cirrhosis of liver. Rifaximin, LOLA, and probiotics are better than giving placebo in patients with MHE.

Clinical profile, genotype and management updates of hepatitis B virus.

Hepatitis B virus (HBV) is a well known agent of acute and chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Around 400 million people worldwide carrier of HBV of which more than 250 million reside in Asia, and 1-2 million people have died from it. It has a partially double-stranded DNA, having 3.2-kb genome size and replicate via reverse transcription of RNA intermediate. In the natural history or during the antiviral therapy of chronic HBV infection, seroconversion from HBeAg to anti-HBeAg is usually accompanied by a decrease in viral replication and remission of liver disease. Based on genomic sequence data HBV is classified into eight genotypes A-H and four major serotypes ayw, ayr, adw and adr on the basis of complete genome and S gene sequence analysis. Genotypes and serotypes are useful tools in understanding the epidemiology of HBV infection. HBV genotypes have distinct geographical distributions. The HBV variants appear during HBeAg seroconversion and they bring mutations in the precore region (PC) that prevent HBeAg synthesis. Another common HBeAg variant is the basal core promoter mutant (BCP) characterized by point mutation in the promoter of both HBeAg mRNA and core protein mRNA. The most frequent core promoter mutation is the double A1762T and G1764A nucleotide exchange, which results in a substantial decrease in HBeAg expression but enhanced viral genome replication. The approved antiviral drugs such as Interferon, lamivudine, adefovir dipivoxil, entecavir and telbivudine for purpose of treating chronic HBV infection is to prevent or stop the progression of liver injury by suppressing viral replication or eliminating infection. Sustained losses of viral markers of active viral replication (HBeAg and HBV DNA) are the standard end point of the therapies.

Distribution of hepatitis B virus genotypes and its association with severity of liver disease in patients with chronic hepatitis B in uttar pradesh, India.

The present study was designed to investigate the distribution of genotypes and its association with severity of liver disease in patients with Chronic Hepatitis B (CHB) in Uttar Pradesh, India. One hundred five HBsAg positive patients were selected for the study. The DNA was extracted by using pure viral DNA extraction kit. The genotype of Hepatitis B virus (HBV) was identified by using polymerase chain reaction- based restriction fragment length polymorphism (PCR-RFLP) method, by using AvaII and DpnII restriction enzyme to see the different patterns of cleavage that would occur at this specific site. Among 105 HBsAg positive chronic liver disease patients 58 patients were positive for HBeAg and 47 samples were HBeAg negative. Genotyping was done successfully in 91 samples. Genotype A was identified in 22% and genotype D in 78% CHB patients. Genotype A showed elevated liver enzymes much more than genotype D. The Child Pugh classification of 20 patients with genotype A was class A (n = 2), B (n = 9), C (n = 9) and of genotype D was class A (n = 13), B (n = 50) and C (n = 8). In conclusion our results showed that Genotype D was the commonest genotype in Uttar Pradesh, whereas genotype A had significantly more elevated ALT/AST levels than genotype D. (P < 0.05). Child Pugh Grade B was significantly more in patients with genotype D, whereas Child Pugh Grade C was more in genotype A.

Significance of alanine aminotransferase testing in diagnosis of acute and chronic HBV infection.

Hepatitis B is a major public health problem world wide; more than 350 million people have chronic infection. Diagnosis of hepatitis is made by biochemical assessment of liver function. Alanine aminotransferase (ALT), a liver enzyme, is markedly elevated in hepatitis and with other causes of acute liver damage associated with hepatic necrosis, blood levels being elevated even before the clinical signs and symptoms of disease such as jaundice appear. HBsAg can be detected in the serum from several weeks before onset of symptoms to several months after onset of acute HBV infection. The presence of HBsAg indicates that the person is potentially infectious. In our study we found that 80% patients who were HBsAg positive had abnormal ALT levels, while the remaining 20% had normal ALT values. This is despite suffering from acute or chronic liver disease, providing a reason why some patients positive for hepatitis B have a normal ALT.

Identification of a hepatitis B virus core promoter mutant by PCR- RFLP in patients suffering from chronic liver disease, Uttar Pradesh, India.

OBJECTIVE: The present study was designed to identify a core promotor mutation in the HBV genome in patients suffering from HBV related chronic liver disease. MATERIALS AND METHODS: 154 chronic liver disease patients were selected for study of DNA extracted using a pure viral DNA extraction kit. The core promoter mutation was detected by the polymerase chain reaction- based restriction fragment length polymorphism (PCR-RFLP) method, using the Sau 3AI restriction enzyme to see if cleavage would occur at this specific site. RESULTS: Among the total of 154, 78 patients were found positive for HBsAg and 71 samples were found to be positive for HBV DNA by first round PCR. The over all prevalence of core mutant was 51(71%) in the 71 patients. 11 (68.8%) of 16 patients, excluding 1 patients with mixed type mutation was detected in inactive HBsAg carriers, 39 (81.3%), excluding 2 patients with mixed type was detected in chronic hepatitis B, and 4/7 (57%) in patients with liver cirrhosis were found. CONCLUSION: Our study concluded that the prevalence of the core promoter mutation in the BCP region was higher in the patients with chronic hepatitis B than in liver cirrhosis and HBsAg carriers. The Sau3AI assay, which is much more convenient than sequencing, was shown to be useful for the detection of the core promoter mutant in an extensive number of clinical samples. Monitoring and detection of HBV variants by PCR-RFLP in chronic infection may improve the management of these patients.