Studies related to portal hypertension

Cirrhosis of the liver is a chronic disorder resulting from a variety of known and unknown aetiological factors, which lead to hepatocyte damage and death, regeneration of remaining hepatocytes and progressive fibrosis in a sequential manner. This ultimately leads to distortion of the architecture of the liver lobules. The net result is liver cell dysfunction and an increase in the intrahepatic resistance to blood flow. The latter, combined with alteration of portal blood flow and of extrahepatic splanchnic vascular responsiveness characterizes portal hypertension.Systemic and splanchnic vasodilatation seem to be prominent features of decompensated hepatic cirrhosis and lead to a fall in the effective circulating blood volume. This results in the activation of a cascade of compensatory events, which include the RAS, release of AVP and heightened sympathetic nervous system activity. Neuronal and humoral mechanisms, therefore, seem to be central to the sodium and water retention, which occurs in cirrhosis of the liver. These pathophysiological changes contribute to fluid retention and ascites.The regulation of arterial tone in cirrhosis of the liver is complex and a multitude of factors seem to be playing a part. The areas which have been explored in the past include the role of endothelial-derived vasodilator agents, circulating vasodilator agents which act on the vascular smooth muscle, and lack of response of the vascular smooth muscle to vasoconstrictor agents.The last could in fact be a result of the first two factors. There is a paucity of data on human tissues in the literature because of difficulty in acquiring larger distributory arteries from cirrhotic patients for experimentation. Blood vessels acquired at OLT offer the opportunity to study donor (normal) and recipient (cirrhotic) blood vessels invitro under controlled standardized conditions (organ bath experiments).The development of portal hypertension itself is followed by clinically important sequelae. Enlargement of the spleen is an early and cardinal sign of portal hypertension and it is difficult to make a diagnosis of portal hypertension without the demonstration of splenomegaly. Factors which participate in the development of splenomegaly include increase in portal pressure and splanchnic blood flow, and RE cell hyperplasia. However, the correlation of spleen size to these factors is not entirely clear. The difficulty in interpreting the results of different studies in this area of medicine is partly due to the lack of information about the accuracy of methods used for determining spleen size and partly due to the paucity of data comparing the different methods of measuring spleen size including ultrasonography, CT scanning, MRI and radionuclide studies. Radionuclides have also been used to quantify splanchnic blood flows as well as liver function in the normal and patients with chronic liver disease but there is again a scarcity of data in this regardThe development of portal hypertension is associated with the opening up of portasystemic collateral shunts at different sites in order to decompress the portal circulation. Clinically important shunt vessels develop in the oesophagus, stomach and the duodenum. These assume varicose proportions and can rupture when the intravascular pressures rise above a threshold value. This can lead to potentially life threatening haemorrhage. Shunting of blood to the systemic circulation is also a contributory factor in hepatic encephalopathyImpairment of glucose tolerance and even the development of diabetes mellitus are also consequences of cirrhosis and portal hypertension occurring in 10-40% of patients. The prevalence of these abnormalities of glycaemic control increases as the duration and severity of liver disease increases. Although, it is generally believed to be a result of insulin resistance at the peripheral receptor sites, the pattern of insulin secretion from the P cells of the pancreas is also believed to be altered in this form of diabetes, particularly in the later stages. However, there are obvious problems in quantifying insulin secretion from the endocrine pancreas as it undergoes significant extraction during first pass through the normal liver and the pulse mass is lost to a large extent. Measurements done at the peripheral vein site are therefore not an accurate reflection of the quantum of insulin secretion over a period of time. TIPSS used to treat complications of portal hypertension are reviewed at portographic examinations and can be used to study the pattern of insulin secretion directly from the portal vein. Although this complex investigation could only be done in a few patients with relatively stable liver function, this human model can be used to study the pattern of insulin secretion in the patients with different grades of severity of liver disease and normal as well as abnormal glucose tolerance in hepatic cirrhosisA number of treatment strategies have been devised for prevention of bleeding and control active bleeding from varices in the gastro-intestinal tract. These include endoscopic sclerotherapy, endoscopic variceal ligation, pharmacological measures including ß adrenoreceptor blocking agents and nitrates, surgical decompressive shunts and TIPSS.TIPSS is the most recent addition to the armamentarium of treatment modalities. Although it is a highly effective of treatment, there are obvious problems in that procedure related and short and long-term complications limit its acceptability. Procedure related complications include intraperitoneal bleeding and subcapsular haematoma in the liver. The main longer-term problems relate to sepsis, precipitation of hepatic encephalopathy and SI and occlusion. A number of shunt and patient related factors have been assessed as predictors of SI and these include, age and sex of patients, the liver functions, pre- and post-stent insertion portal pressures and the diameter of the stent. The role of diabetes mellitus, which has been shown to encourage stenosis in vascular stents placed elsewhere in the body, has not been assessed in TIPSS.Accordingly, the aim of this thesis was to explore the following aspects of hepatic cirrhosis and portal hypertension.1.1 TO STUDY THE PATHOPHYSIOLOGIC MECHANISM OF VASCULAR HYPORESPONSIVENESS IN HEPATIC CIRRHOSIS. • The aim in these experiments was to investigate the role of NO release in modulating a-adrenoceptor mediated contraction in hepatic cirrhosis.1.2 TO STUDY CLINICAL SEQUELAE OF PORTAL HYPERTENSION DUE TO HEPATIC CIRRHOSIS. These were the areas of study in relation to clinical sequelae: • The clinical aspects of splenomegaly and its relation to portal haemodynamic factors in portal hypertension due to hepatic cirrhosis. • The role of radionuclides in measuring spleen size and assessing liver function in hepatic cirrosis and portal hypertension.1.3 TO STUDY THE PATTERN OF INSULIN SECRETION IN CIRRHOTIC PATIENTS WITH TIPSS AND THE IMPACT OF DIABETES MELLITUS ON TIPSS FUNCTION. • The pattern of pulsatile insulin secretion in portal vein in patients suffering from hepatic cirrhosis using a TIPSS inserted model was studied. This model should help study pattern of insulin secretion in different stages of hepatogenous diabetes mellitus, ie., impaired glucose tolerance and frank diabetes mellitus. • The effect of diabetes mellitus on the efficacy of TIPSS in the treatment of patients suffering from portal hypertension has been studie

Use of Mercury Intrusion Porosimetry (MIP) Technique to Measure the Porosity of Anodes in Solid Oxide Fuel Cell (SOFC)

The present research is aimed to calculating the porosity of anodes in solid oxide fuel cell through Mercury Intrusion porosimetry (MIP). There are various techniques used to measure the porosity of the solid oxide fuel cell (SOFC). MIP is a method used to find the porosity of anodes due to its high accuracy, and some additional information which includes particle size distribution, pore size distribution, average pore size and bulk density. The working principal of MIP is that when sample is filled with mercury then high pressure is applied which makes the mercury to penetrate into the pores of the sample. The instrument measures the pore volume with the help of capacitive system as the pressure gradually increases to its maximum value and then decrease to its lowest value. This system calculates the volume of mercury intruded for each pressure whether the pressure is increasing or decreasing. The instrument is connected to a computer with dedicated software which calculates the percentage porosity of the sample. The results suggested the importance of PH and agitator on porosity. What we have to provide is the sample mass, sample density and the temperature of the laboratory. However for cleaning purposes of mercury, ethanol could be used instead of acetone, as mercury intrusion porosimeter involves few plastic parts like dilatometer holder and cap. Whereas acetone has catastrophic effect on them, and these parts are very expensive to replace. Keywords: Mercury, Intrusion, Solid oxide, Fuel cell, Porosity, Anodes, Porosimetr

Socio-economic analysis of the interventions aimed at improving water and sanitation condition of rural community

Present research has been aimed to assess the socio-economic analysis of the water and sanitation interventions made by the government in rural areas of District Abbottabad, KPK, Pakistan. A cross-sectional study design was employed to collect data from the relevant actors with the help of interviews, questionnaires and focus group discussions. Respondents were satisfied with the cost of the water delivery at home and the quality of water was also appreciable. Majority of the people described the strengthened pardha system (Privacy), as major advantage of the interventions. In terms of economic benefits by the interventions it was quiet good. But still top down approach is used for implementation of water supplies schemes and sanitation interventions by the government which is not satisfactory indicator for maximizing the benefits. Keywords: Water and sanitation, Rural, Interventions, , socio-economi

An integrated approach towards identification of the barriers to implementation of rooftop Rainwater Harvesting Systems in urban residential areas of Pakistan

Water conservation in relation to rooftop Rainwater Harvesting Systems for urban residential areas is underdeveloped in Pakistan. Due to increased urbanisation, water availability in the domestic sector is stressed in terms of the quality and quantity of water resources. Rawalpindi the 4th largest city was selected as a case study for this research. The purpose of this research was to assess the feasibility of implementing rooftop Rainwater Harvesting Systems for non-potable purposes in urban residential areas of Pakistan. The study included four focus areas; (i) A technical feasibility assessment of rooftop Rainwater Harvesting Systems in relation to annual/monthly rainfall data, current non-potable water demand and rooftop catchment., (ii) A questionnaire survey aimed at households in residential areas to identify socio-economic barriers/attitudes to rooftop Rainwater Harvesting Systems and (iii) Face to face interviews with policy-makers to identify the current policy implementation barriers regarding rooftop Rainwater Harvesting Systems. In terms of data and results the study demonstrated that Rooftop Rainwater Harvesting Systems are technically feasible in urban residential areas of Rawalpindi in terms of roof catchment area and rainwater as a potential source of non-potable water. Household surveys showed that majority of the respondents were relatively unwilling to implement rooftop Rainwater Harvesting Systems. Major reasons for this included a lack of systems knowledge and awareness. In addition, concerns about water quality and maintenance presented significant barriers for respondents. Similarly, respondents reported that financial barriers were constraints to implementing rooftop Rainwater Harvesting Systems; large numbers of respondents were “very much willing” to install systems but only if local government provided incentives. In terms of qualitative analysis, interviews with different stakeholders involved in policy formulation to policy implementation showed poor commitment and a lack of understanding and coordination. There were ambiguities in the process of policy formulation to the implementation of rooftop Rainwater Harvesting Systems; the policy process is complex and lacks a cohesive strategy. Last but not least poor monitoring and evaluation of the policy document were found to be barriers in the implementation of rooftop Rainwater Harvesting Systems

Save water and safe water: Evaluation of design and storage period on water quality of rainwater harvesting system

The present research has been aimed to assess the appropriateness of different aspects of rooftop rainwater harvesting system as an alternative of ground water installed at Chitra Topi. 25 households were purposively selected for the collection of relevant data with the help of interview schedules, focus group discussions, and water sampling. Average rooftop area of surveyed households was 100 m2. Ideal storage system and proper management of surplus during peak seasons can ensure water availability throughout the year. From quality perspective, there are few issues in the physical, chemical and microbiological parameters. But by the introduction of simple components there problems can be rectified to a large extent. Based on results, it is concluded that rain water harvesting systems were shown to be a relatively low cost option for improving a households’ geographical and temporal access to a water source, increasing convenience and decreasing collection times. Keywords: Rainwater, Harvesting, Design, Water qualit

A Study on the House Financing Facilities by Banks Compared with HBFC

From the beginning of this world man has three basic needs i.e. food, clothing and shelter. In the modern world, it doesn’t matter that you belong to which class of society, everyman has a desire for his own house where he/she could live safely with his/her family. Therefore, the demand for houses has always been there and will remain as long as there are human beings on this planet. Housing and development of any country are synonymous to each other as these are mutually supportive. Housing is an important part of strategy of any government for the alleviation of poverty and employment generation and is to be viewed as an integral part of overall improvement and economic development as fifty allied industries such as cement, iron and steel, aluminum, paints, sanitary, carpets, stone crushing etc. depends on this industry alone. Almost all countries of the world have private and public sectors housing development and finance organization which have mobilized enormous personal factors resources and are contributing frequently to the national economy. The housing sector requirements and the subjective conditions in Pakistan clearly establish that there is a dire need for such organizations to supplement the present efforts of the government. Pakistan housing finance sector is highly underdeveloped. In the developed countries on an average housing finance represent over 25% of GDP (Journal of The Institute of Bankers Pakistan) which is quite high as compared to under developing countries

Posterior Mediastinal Chondrosarcoma- A rare entity

Introduction:Chondrosarcoma is a well defined tumor of soft tissue with calcification. Extraskeletal myxoid chondrosarcoma is an unusual sarcoma of soft tissue adding only 3% to all soft tissue tumors. Majority of mediastinal foci originates from variety of tissues, the reason being their diverse embryological and anatomical approximations. Chondrosarcomas are more common in males with 2:1 male to female ratio. The exact pathology of these tumors is unclear; however recent data ensures that these tumors have multidirectional delineation. Classical histopathological features of chondrosarcoma include S-100 positivity, EMA positivity. These features of Immunohistochemical favor extra skeletal myxoid chondrosarcoma.Case Report:Recent data signifies that the tumor is known for its rare occurrence, here we have reported a unique case of 40 years old male visited Abbasi Shaheed Hospital for pre employment checkup without any symptoms. All the tests were negative except Chest X-ray PA view which revealed dense mass on lower lobe of lung. For further evaluation, CT scan of chest with contrast was ordered and eventually the mass was resected surgically. On the basis of macro and microscopic findings, histopathological tests and immunohistochemical stains, the mass was found to be chondrosarcoma with myxoid origin. This tumor has to be distinguishing among the list of different diseases like hamartoma, hydatid cyst, and neuroendocrine tumors for the differential diagnosis of the case.Conclusion: Our paper reports an extraskeletal mesenchymal chondrosarcoma originating in the posterior mediastinum with a rare presentation.Â

Observations on the avifauna of Miani Hor, Balochistan

Miani Hor, a Ramsar site, is an important coastal wetland along Arabian Sea. This is the only area on Pakistan coast where three species of mangroves grow naturally. This paper presents the observations on avian fauna recorded from the area during October 1997 to June 2002. The paper reports the occurrence of 70 species of birds belonging to 10 Orders and 27 Families from the area. Out of which 37 species are migratory. The preferred habitat of various species and their status has also been given

Resection of posterior mediastinal tumors by video assisted thoracic surgery

Abstract This case report illustrates successful Video Assisted Thoracic Surgery (VATS) performed on a 45-year-old woman and 52-year-old man presenting with a mass in left and right paravertebral space on the CT scan respectively. VATS has many benefits over traditional open operation (thoracotomy), resulting in less pain and shorten recovery time. However, VATS has higher equipment cost but when an experienced surgeon performs the surgery, better outcomes are achieved. VATS is not common in Pakistan\u27s surgical setup as it is an expensive method of eradicating mediastinal pathologies and not every patient undergoes VATS. The primary objective of presenting these cases is to promote the use of VATS specifically for removal of posterior mediastinal tumors and improve the surgical outcomes

The Impact of Religiosity and Spirituality on Academic Dishonesty of Students in Pakistan

Business ethics has become a very popular topic in recent decades and having news on media on a daily basis which is now increased in a number of high profile business scandals that shook the business world. That is the cause of academy dishonesty of students in many universities and colleges where student training of ethics are very low for such kind of business scandals emerged. There are two factors which are under research in this topic in academy dishonest and cheating behavior which are religiosity and spirituality. This study shed lights on the religious beliefs and unethical behaviors by focusing the students of Pakistan which are studying at Universities level having academic dishonesty and cheating behavior. The individual attitudes, views, decisions making and the behaviors according to the situation are influenced by religiosity and spirituality which are posited in this study. The objective of this research is to find out the relationship between religiosity and spirituality on cheating behavior with the help of cheating attitude as mediator. A cross-sectional study conducted on the postgraduate student in Pakistan and collected from four post-graduate institutes in Lahore, which are COMSATS, NCBA&E, UMT and Punjab University. So the result of this research shows that religiosity but not spirituality is a predictor of attitudes of the student toward cheating and cheating behavior